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Operator’s Manual
AVEA
Ventilator Systems
L2786 Rev. D
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AVEA Ventilator Systems
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Revision History
Date
Revision
September 2005
A
All
Release
May 2006
B
1-1, 1-4, 2-7, 2-10
Removed references to the Plus model
2-12
Removed “non-operational” from figure 2-19
3-16, 3-18, 3-21, 3-33,
3-34, 3-35,
Added a note regarding the setting of Peak
Inspiratory Pressure
5-3
Added Ppeak to the list of alert messages
2-31
Updated the Primary Controls table
2-36
Added NCPAP to the troubleshooting table
3-33
Updated the Rate specification
5-1 to 5-7
Added the chapter “Infant NCPAP”
4-7
Updated the figure and added a description of the
balloon size and type selection
4-25
Added a note regarding the date and time
December 2006
February 2007
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Changes
iv
AVEA Ventilator Systems
Warranty
THE AVEA® ventilator systems are warranted to be free from defects in material and workmanship and to meet the
published specifications for Two (2) years or 16,000 hours, whichever occurs first.
The liability of VIASYS Respiratory Care Inc. (referred to as the Company) under this warranty is limited to replacing,
repairing or issuing credit, at the discretion of the Company, for parts that become defective or fail to meet published
specifications during the warranty period; the Company will not be liable under this warranty unless (A) the Company is
promptly notified in writing by Buyer upon discovery of defects or failure to meet published specifications; (B) the
defective unit or part is returned to the Company, transportation charges prepaid by Buyer; (C) the defective unit or part
is received by the Company for adjustment no later than four weeks following the last day of the warranty period; and (D)
the Company’s examination of such unit or part shall disclose, to its satisfaction, that such defects or failures have not
been caused by misuse, neglect, improper installation, unauthorized repair, alteration or accident.
Any authorization of the Company for repair or alteration by the Buyer must be in writing to prevent voiding the warranty.
In no event shall the Company be liable to the Buyer for loss of profits, loss of use, consequential damage or damages of
any kind based upon a claim for breach of warranty, other than the purchase price of any defective product covered
hereunder.
The Company warranties as herein and above set forth shall not be enlarged, diminished or affected by, and no
obligation or liability shall arise or grow out of the rendering of technical advice or service by the Company or its agents
in connection with the Buyer's order of the products furnished hereunder.
Limitation of Liabilities
This warranty does not cover normal maintenance such as cleaning, adjustment or lubrication and updating of
equipment parts. This warranty shall be void and shall not apply if the equipment is used with accessories or parts not
manufactured by the Company or authorized for use in writing by the Company or if the equipment is not maintained in
accordance with the prescribed schedule of maintenance.
The warranty stated above shall extend for a period of TWO (2) years from date of shipment or 16,000 hours of use,
whichever occurs first, with the following exceptions:
1.
Components for monitoring of physical variables such as temperature, pressure, or flow are warranted for ninety
(90) days from date of receipt.
2.
Elastomeric components and other parts or components subject to deterioration, over which the Company has no
control, are warranted for sixty (60) days from date of receipt.
3.
Internal batteries are warranted for ninety (90) days from the date of receipt.
The foregoing is in lieu of any warranty, expressed or implied, including, without limitation, any warranty of
merchantability, except as to title, and can be amended only in writing by a duly authorized representative of the
Company.
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Operator’s Manual
Contents
Revision History........................................................................................................iii
Warranty ....................................................................................................................iv
Notices ......................................................................................................................vii
Safety Information ....................................................................................................ix
Equipment Symbols .................................................................................................xi
Chapter 1 Introduction.........................................................................................1-1
Some AVEA Features ..................................................................................................................1-2
Chapter 2 Unpacking & Setup.............................................................................2-1
Ventilator Assembly & Physical Setup.......................................................................................2-1
Setting Up the Front of the Ventilator ........................................................................................2-3
Front Panel Connections.............................................................................................................2-7
Setting Up the Rear of the Ventilator........................................................................................2-14
User Verification Test ................................................................................................................2-26
AVEA User Verification Test Checklist ....................................................................................2-33
AVEA Troubleshooting..............................................................................................................2-34
Chapter 3 Ventilator Operation ...........................................................................3-1
Membrane Buttons and LEDs .....................................................................................................3-1
Patient Setup ................................................................................................................................3-9
Ventilation Setup........................................................................................................................3-10
Setting the Ventilation Breath Type and Mode........................................................................3-14
Primary Breath Controls............................................................................................................3-31
Advanced Settings.....................................................................................................................3-37
Independent Lung Ventilation (ILV)..........................................................................................3-44
Chapter 4 Monitors, Displays and Maneuvers ..................................................4-1
Graphic Displays..........................................................................................................................4-1
Digital Displays ..........................................................................................................................4-20
Main Screen Displays ................................................................................................................4-26
Chapter 5 Infant NCPAP ......................................................................................5-1
Overview .......................................................................................................................................5-1
Circuit Compatibility ....................................................................................................................5-1
General Specifications ................................................................................................................5-1
Initiating Nasal CPAP...................................................................................................................5-3
Monitors ........................................................................................................................................5-5
Graphics........................................................................................................................................5-6
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Chapter 6 Alarms and Indicators........................................................................6-1
Status Indicators.......................................................................................................................... 6-1
Messages...................................................................................................................................... 6-3
Alarms........................................................................................................................................... 6-4
Alarm Controls............................................................................................................................. 6-5
Alarm Types ................................................................................................................................. 6-6
Chapter 7 Maintenance and Cleaning................................................................7-1
Cleaning & Sterilization............................................................................................................... 7-1
Disposable Parts.......................................................................................................................... 7-2
Other Accessories ....................................................................................................................... 7-2
Recommended Periodic Maintenance ....................................................................................... 7-3
Battery Care ................................................................................................................................. 7-4
Fuses ............................................................................................................................................ 7-6
Appendix A Contact & Ordering Information................................................... A-1
How to Call for Service................................................................................................................A-1
Ordering Parts..............................................................................................................................A-2
Appendix B Specifications................................................................................. B-1
Pneumatic Supply........................................................................................................................B-1
Electrical Supply..........................................................................................................................B-1
Data Input / Output ......................................................................................................................B-2
Atmospheric & Environmental Specifications ..........................................................................B-5
Physical Dimensions...................................................................................................................B-5
Accessories..................................................................................................................................B-6
Appendix C Pneumatic Diagram ....................................................................... C-1
Gas Delivery Engine ....................................................................................................................C-1
Appendix D Monitor Ranges and Accuracies .................................................. D-1
Appendix E Sensor Specifications & Circuit Resistance ............................... E-1
VarFlex® Sensor Specifications................................................................................................. E-1
Hot Wire Flow Sensor Specifications ........................................................................................ E-2
Circuit Resistance (per EN794 –1).............................................................................................. E-2
Appendix F AVEA Message Bar Text.................................................................F-1
Appendix G Adjusting Barometric Pressure for Altitude ............................... G-1
Appendix H Advanced Pulmonary Mechanics Monitored Parameters.......... H-1
Appendix I Glossary .............................................................................................I-1
Index ........................................................................................................................... 3
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Operator’s Manual
Notices
Copyright Notice
Copyright© 2005 VIASYS Respiratory Care Inc, California.
This work is protected under Title 17 of the U.S. Code and is the sole property of the Company. No part of this document
may be copied or otherwise reproduced, or stored in any electronic information retrieval system, except as specifically
permitted under U.S. Copyright law, without the prior written consent of the Company. For more information, contact:
European Authorized Representative
USA
VIASYS Respiratory Care Inc.
22745 Savi Ranch Parkway
Yorba Linda, California 92887-4645
Telephone: +1 800 231-2466
+1 714 283-2228
Fax: +1 714 283-8471
VIASYS Healthcare GmbH
Leibnizstrasse 7
97204 Hoechberg
Germany
Telephone: +49 931 4972-0
Fax: +49 931 4972-423
www.viasyshealthcare.com
Trademark Notices
AVEA® is a registered trademark of VIASYS Respiratory Care Inc. in the U.S. and some other countries. All other brand
names and product names mentioned in this manual are trademarks, registered trademarks, or trade names of their
respective holders.
EMC Notice
This equipment generates, uses, and can radiate radio frequency energy. If not installed and used in accordance with
the instructions in this manual, electromagnetic interference may result. The equipment has been tested and found to
comply with the limits set forth in EN60601-1-2 for Medical Products. These limits provide reasonable protection against
electromagnetic interference when operated in the intended use environments (e.g. hospitals) described in this manual.
This ventilator is also designed and manufactured to comply with the following standards EN 60601-1, IEC 601-2-12, EN
60601-1-2, EN 794-1, CAN/CSA-C22.2 No. 601.1-M90, and UL 2601-1.
MRI Notice
This equipment contains electromagnetic components whose operation can be affected by intense electromagnetic
fields.
Do not operate the ventilator in a MRI environment or in the vicinity of high-frequency surgical diathermy equipment,
defibrillators, or short-wave therapy equipment. Electromagnetic interference could disrupt the operation of the ventilator.
Intended Use Notice
The AVEA ventilator systems are designed to provide ventilator support for the critical care management of infant,
pediatric or adult patients with compromised lung function. They are intended to provide continuous respiratory support
in an institutional health care environment (e.g. a hospital). They should only be operated by properly trained clinical
personnel, under the direction of a physician.
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AVEA Ventilator Systems
Regulatory Notice
Federal law restricts the sale of this device except by or on order of a physician.
Classification
Type of Equipment:
Medical Equipment, Class 1 type B
Adult/Pediatric/Infant Lung Ventilator
Declaration of Conformity Notice
This medical equipment complies with the Medical Device Directive, 93/42/EEC, and the
following Technical Standards, to which Conformity is declared:
EN 794-1
EN 60601-1
EN 60601-1-2
ISO 13485
EU Notified Body:
BSI (Reg. No. 0086)
Trade names:
AVEA ventilator systems
Manufactured by:
VIASYS Respiratory Care Inc.
1100 Bird Center Drive
Palm Springs, CA 92262-8099
U.S.A.
If you have a question regarding the Declaration of Conformity for this product, please contact VIASYS Respiratory Care
Inc. at one of the numbers given in Appendix A.
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Operator’s Manual
Safety Information
Please review the following safety information prior to operating the ventilator. Attempting to operate the
ventilator without fully understanding its features and functions may result in unsafe operating conditions.
Warnings and Cautions, which are general to the use of the ventilator under all circumstances, are included in this
section. Some Warnings and Cautions are also inserted within the manual where they are most meaningful.
Notes are also located throughout the manual to provide additional information related to specific features.
If you have a question regarding the installation, set up, operation, or maintenance of the ventilator, contact VIASYS
Respiratory Care Inc., Customer Care, as shown in Appendix A Contact & Ordering Information.
Terms
WARNINGS
identify conditions or practices that could result in serious adverse reactions or potential safety
hazards.
CAUTIONS
identify conditions or practices that could result in damage to the ventilator or other equipment.
NOTES
identify supplemental information to help you better understand how the ventilator works.
Warnings
Warnings and Cautions appear throughout this manual where they are relevant. The Warnings and Cautions
listed here apply generally any time you operate the ventilator.
The AVEA Ventilator is intended for use by a trained practitioner, under the direction of a qualified physician.
When the ventilator is connected to a patient, a trained health care professional should be in attendance at all times
to react to an alarm or other indications of a problem.
Alarm loudness must be set above ambient sound in order to be heard.
Always have an alternate means of ventilation available whenever the ventilator is in use.
The operator should not touch the electrical connectors of the ventilator or accessories, and the patient
simultaneously.
Due to possible explosion hazard, the ventilator should not be used in the presence of flammable anesthetics.
An audible alarm indicates an anomalous condition and should never go unheeded.
Anti-static or electrically conductive hoses or tubing should not be used within the patient circuit.
If a mechanical or electrical problem is recognized while operating the ventilator, the ventilator must be removed
from use and referred to qualified personnel for servicing. Using an inoperative ventilator may result in patient
injury.
When a low gas supply alarm occurs, the oxygen concentration delivered to the patient will differ from that set on the
O2 control setting.
A source gas failure will change the FIO2 and may result in patient injury.
The functioning of this equipment may be adversely affected by the operation of other equipment nearby, such as
high frequency surgical (diathermy) equipment, defibrillators, short-wave therapy equipment, “walkie-talkies,” or
cellular phones.
Water in the air supply can cause malfunction of this equipment.
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AVEA Ventilator Systems
Do not block or restrict the Oxygen bleed port located on the instrument back panel. Equipment malfunction may
result.
Electric shock hazard - Do not remove any of the ventilator covers or panels. Refer all servicing to an authorized
VIASYS Respiratory Care service technician.
A protective ground connection by way of the grounding conductor in the power cord is essential for safe operation.
Upon loss of protective ground, all conductive parts including knobs and controls that may appear to be
insulated can render an electric shock. To avoid electrical shock, plug the power cord into a properly wired
receptacle, use only the power cord supplied with the ventilator, and make sure the power cord is in good
condition.
The AVEA is designed to ensure that the user and patient are not exposed to excessive leakage current per
applicable standards (UL2601 and IEC60601-1). However, this cannot be guaranteed when external devices
are attached to the ventilator. In order to prevent the risk of excessive enclosure leakage current from external
equipment attached to the RS-232, printer and video ports, isolation of the protective earth paths must be
provided to ensure proper connection. This isolation should ensure that the cable shields are isolated at the
peripheral end of the cable.
Cautions
The following cautions apply any time you work with the ventilator.
Ensure that the voltage selection and installed fuses are set to match the voltage of the wall outlet, or damage may
result.
A battery that is fully drained (i.e. void of any charge) may cause damage to the ventilator and should be replaced.
All accessory equipment that is connected to the ventilator should comply with CSA/IEC601/UL2601.
To avoid damage to the equipment, clean the air filter regularly.
The following cautions apply when cleaning the ventilator or when sterilizing ventilator accessories.
Do not sterilize the ventilator. The internal components are not compatible with sterilization techniques.
Do not gas sterilize or steam autoclave tubing adapters or connectors in place. The tubing will, over time, take the
shape of the adapter, causing poor connection and possible leaks.
DO NOT submerge the ventilator or pour cleaning liquids over or into the ventilator.
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Equipment Symbols
The following symbols may be referenced on the ventilator or in accompanying documentation
Symbol
Source/Compliance
Symbol #03-02 IEC 60878
Indicates ATTENTION, consult ACCOMPANYING DOCUMENTS
Symbol #5016 IEC 60417
This symbol indicates a FUSE.
Symbol #5034 IEC 60417
Symbol #01-36 IEC 60878
Symbol #5035 IEC 60417
Symbol #01-37 IEC 60878
Symbol #5031 IEC 60417
Symbol #5019 IEC 60417
Symbol #01-20 IEC 60878
Symbol #5021 IEC 60417
Symbol # 01-24 IEC 60878
Symbol # 5333 IEC 60417
Symbol #02-03 IEC 60878
Symbol #5032 IEC 60417
This symbol indicates INPUT.
This symbol indicates OUTPUT
This symbol indicates DIRECT CURRENT (DC)
This symbol indicates protective EARTH (ground).
This symbol indicates the EQUIPOTENTIAL connection used to
connect various parts of the equipment or of a system to the same
potential, not necessarily being the earth (ground) potential (e.g., for
local bonding).
This symbol indicates TYPE B equipment, which indicates equipment
that provides a particular degree of protection against electric shock,
particularly with regards to allowable leakage current and reliability of
the protective earth connection.
Symbol #01-14 IEC 30878
This symbol is located on the rating plate. It indicates the equipment is
suitable for alternating current.
Symbol #5007 IEC 60417
Symbol #01-01 IEC 60878
Indicates ON (Power)
Symbol #5008 IEC 60417
Symbol #01-02 IEC 60878
Indicates OFF (Power)
Symbol #0651 ISO 7000
Horizontal return with line feed. Indicates ACCEPT entered values for
a specific field.
VIASYS Respiratory Care
Symbol
Indicates PATIENT EFFORT
VIASYS Respiratory Care
symbol
Indicates MANUAL BREATH
ACCEPT
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AVEA Ventilator Systems
CANCEL
VIASYS Respiratory Care
Symbol
MAIN SCREEN
Symbol #417 IEC 5102
EVENT READY
VIASYS Respiratory Care
Symbol
MODE
VIASYS Respiratory Care
Symbol
ADVANCED SETTINGS
VIASYS Respiratory Care
Symbol
SET-UP for patient size selection
MDD Directive 93/42/EEC
CE Mark
Symbol #5307 IEC 60417
ALARM RESET
Symbol #5319 IEC 60417
ALARM SILENCE
VIASYS Respiratory Care
symbol
ADULT patient
VIASYS Respiratory Care
symbol
PEDIATRIC patient
VIASYS Respiratory Care
symbol
NEONATAL (Infant) patient
Graphical Symbol in
general use internationally
for “DO NOT”
CANCEL, i.e. do not accept entered values.
VIASYS Respiratory Care
symbol
Select DISPLAYED SCREEN function.
Symbol 5467 IEC 60417
FREEZE the current display.
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VIASYS Respiratory Care
symbol
Enable the ALARM LIMITS screen
VIASYS Respiratory Care
symbol
This symbol indicates a CONTROL LOCK.
VIASYS Respiratory Care
symbol
NEBULIZER port
VIASYS Respiratory Care
symbol
Increase OXYGEN
VIASYS Respiratory Care
symbol
PRINT SCREEN
VIASYS Respiratory Care
symbol
SUCTION port
VIASYS Respiratory Care
symbol
VARIABLE ORIFICE FLOW SENSOR connection
VIASYS Respiratory Care
symbol
HOT WIRE FLOW SENSOR connection
VIASYS Respiratory Care
symbol
ANALOG IN/OUT connection
VIASYS Respiratory Care
symbol
Display the MAIN SCREEN
VIASYS Respiratory Care
symbol
DO NOT BLOCK PORT
VIASYS Respiratory Care
symbol
EXTERNAL BATTERY connection
VIASYS Respiratory Care
symbol
Indicates GAS ID port
VIASYS Respiratory Care
symbol
OXYGEN SENSOR connection
xiv
AVEA Ventilator Systems
VIASYS Respiratory Care
symbol
OVERPRESSURE relief
VIASYS Respiratory Care
symbol
REMOTE NURSE CALL connection
VIASYS Respiratory Care
symbol
USER INTERFACE MONITOR connection
VIASYS Respiratory Care
Symbol
This symbol indicates an INTERNAL BATTERY FUSE
VIASYS Respiratory Care
Symbol
This symbol indicates ALARM LOUDNESS
VIASYS Respiratory Care
Symbol
VIASYS Respiratory Care
Symbol
This symbol indicates that the AVEA is being powered by the
INTERNAL BATTERY only.
This symbol indicates that the HELIOX configuration is in use.
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Chapter 1 Introduction
The AVEA is a fourth generation, servo-controlled, software-driven ventilator. It has a dynamic range of breathing gas
delivery that provides for neonatal through adult patients. Its revolutionary user interface module (UIM) provides
maximum flexibility with simple operator interaction. It has a flat panel color LCD with real time graphic displays and
digital monitoring capabilities, a touch screen for easy interaction, membrane keys and a dial for changing settings and
operating parameters. A precision gas delivery engine with servo controlled active inhalation and exhalation improves
performance over previous generations.
The AVEA has been designed to function using most commonly available accessories. It is easy to clean and its design
does not allow liquids to pool on the casing, reducing the likelihood of fluid leakage into the body of the ventilator.
There are two models of AVEA: Comprehensive and Standard. The following table shows the standard and optional
functions available with each model.
Functions & Accessories
Standard
Comprehensive
All
All
Custom Cart
Option
Included
External Battery (on custom cart only)
Option
Option
Gas Tank Holder (on either cart)
Option
Option
Internal Compressor
Option
Included
Heliox Delivery
Option
Included
Modes
Proximal Hot Wire Flow Sensing
Synchronized Nebulizer
24 Hour Trending
Internal Battery
Full Color Graphics Display
Loops and Waveforms
Standard Cart
Proximal Variable Orifice flow sensing
Proximal Airway Pressure Monitoring
Tracheal Catheter
Esophageal Balloon
Internal Compressor
Heliox Delivery
Optional Functions & Accessories
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Chapter 1 Introduction
AVEA Ventilator Systems
Some AVEA Features
Artificial Airway Compensation1
When Artificial Airway Compensation is turned on, the ventilator automatically calculates the pressure drop across the
endotracheal tube, then adjusts the airway pressure to deliver the set inspiratory pressure to the distal (carina) end of the
endotracheal tube. This calculation takes into account flow, gas composition (Heliox or Nitrogen/Oxygen), Fraction of
Inspired Oxygen (FiO2), tube diameter, length, and pharyngeal curvature based on patient size (Neonatal, Pediatric,
Adult). This compensation only occurs during inspiration. Artificial Airway Compensation is active in all Pressure
Support and Flow Cycled Pressure Control Breaths.
WARNING
Activating of Artificial Airway Compensation while ventilating a patient will cause a sudden increase in the peak
airway pressures and a resultant increase in tidal volume. If you choose to activate Artificial Airway
Compensation while the patient is attached to the ventilator you will need to exercise caution to minimize the
risk of excessive tidal volume delivery.
Note:
Monitored airway pressures (inspiratory) will be higher than set values when Artificial Airway Compensation is active.
With an inspiratory pressure setting of zero, Artificial Airway Compensation will still provide an elevated airway pressure,
which will compensate for the resistance of the endotracheal tube.
When turned on the Artificial Airway Compensation indicator will appear in all modes of ventilation even though the
function may not be active (i.e.: Volume Controlled Breaths). This is to alert you to the fact that Artificial Airway
Compensation will become active if a Pressure Support or combination mode (e.g. Volume Control SIMV) is selected.
Range:
Off/On
Default:
Off
Available in all patient sizes
Full range of Patient Size
You can select a patient size of Adult, Pediatric, or Neonate. Once the selection is made, the ventilator offers only those
parameters, which are available for your selected patient size.
Non-Invasive Ventilation
The ventilator can perform non-invasive ventilation with a standard dual limb circuit. Leak compensation should be
turned on when using this feature. To turn leak compensation on, use the touch screen control displayed in the Ventilator
Set-Up Screen.
NOTE
Non invasive ventilation requires the use of a snug fitting mask with no bleed holes. Excessive leaks around the mask
may result in false triggering of the ventilator or assertion of disconnect alarms.
1
Estimation of Inspiratory Pressure Drop in Neonatal and Pediatric Endotracheal Tubes, by Perre-Henri Jarreau, American Physiological Society 1999
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1-3
Leak Compensation
Leak Compensation is used to compensate for baseline leaks, which may occur at the patient mask interface or around
the patient’s endotracheal tube. It only provides baseline leak compensation and is not active during breath delivery.
During exhalation, PEEP is maintained by the cooperation of the Flow Control Valve (FCV) and the Exhalation Valve
(ExV). The ExV pressure servo is set to a target pressure of PEEP and the FCV pressure servo is set to a pressure
target of PEEP - 0.4 cmH2O. The ExV servo relieves when the pressure is above its target and the FCV supplies flow
when the pressure drops below its target up to a maximum flow rate for the patient size
Range:
Off/On
Default:
Off
Circuit Compliance Compensation
When Circuit Compliance is active, the volume of gas delivered during a volume controlled or targeted breath is
increased to include the set volume, plus the volume lost due to the compliance effect of the circuit. Circuit Compliance
is active for the set Tidal Volume during volume control ventilation, the Target Tidal Volume in PRVC mode and for
Machine Volume. It is only active in Adult and Pediatric applications.
Exhaled volume monitors for all modes and breath types are also adjusted for the compliance compensation
volume.
Range:
0.0 to 7.5 ml/cmH2O
Default:
0.0 ml/cmH2O
The ventilator automatically measures Circuit Compliance during the Extended Systems Test (EST). It can also be
entered manually.
Note:
Although circuit compliance is displayed on the Setup screen it is not active for neonatal patients..
High circuit compliance with small tidal volumes may result in extended inspiratory times. This is a result of the delivery
of the circuit compliance volume at the set flow rate.
Setting extremely small delivered tidal volumes with Circuit Compliance Compensation not active and using a proximal
flow sensor may result in assertion of Patient Circuit Disconnect Alarms.
Humidification
You can select active or passive humidification (ON/active or OFF/passive). Active humidification assumes 99% RH;
passive assumes 60% RH when using an HME. This feature adjusts the BTPS correction factor to correct exhaled tidal
volumes.
Range:
Default:
Off/On
Active (ON)
Note:
Incorrect setting of the Humidification feature will affect monitored exhaled volume accuracy.
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Chapter 1 Introduction
AVEA Ventilator Systems
Heliox Delivery (Comprehensive only, option on Standard)
Using patented “Smart” connector technology, the Comprehensive model AVEA can deliver Heliox blended gas instead
of Medical air. By simply changing a connector on the back panel, the ventilator identifies the gas input and adjusts to
accommodate the change. All volumes (numeric and graphic) are automatically compensated for accurate display.
The clinical benefits of helium / oxygen gas are based on its significantly lower gas density when compared to nitrogen /
oxygen gas. This lower gas density allows the same volumetric (tidal volume) of gas to be delivered to the patient at a
significantly lower airway pressure. Additionally, the low-density properties of the gas allow it to diffuse past airway
obstructions or restrictions much easier than nitrogen / oxygen gas mixtures.
Note
The Heliox “smart” connector is designed for use with an 80/20 Heliox tank only. Only a mixture of 20% oxygen and
80% Helium can be used as the Heliox gas supply.
If Heliox gas is connected this green icon displays in bottom right of the touch screen.
To set the Helium / Oxygen mixture during administration simply set the desired FiO2, the balance of the breathing gas is
Helium.
For example:
A set FiO2 of 35% will deliver a 65/35 Heliox mixture to the patient.
WARNING
Connection of a gas supply at the Helium-Oxygen mixture inlet that does not contain 20% oxygen can cause
hypoxia or death.
Although an 80/20 mixture of Helium and Oxygen is marketed as medical gas, the Helium/Oxygen gas mixture is
not labeled for any specific medical use.
Note
Hot wire flow sensors will not function with Heliox gas mixtures. During Heliox delivery, a variable orifice flow sensor
should be used for monitoring delivered volumes at the proximal airway.
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Note
Heated humidifier performance should be carefully monitored during Heliox therapy. Helium has significantly
greater thermal conductivity compared to nitrogen / oxygen gas mixtures and this could cause difficulty with some heated
humidification devices. A febrile patient may transfer heat via the gas column to a proximal temperature sensor, which
could affect the duty cycle of the humidifier and decrease output. This could cause desiccation of secretions in the
airway.
Alternately, in applications where a heated wire breathing circuit is used, this heat transfer from the patient may affect
the duty cycle of the heated wire circuit, which may result in increased condensation in the breathing circuit.
The relative settings of some types of humidifiers may need to be reduced to prevent overheating of the breathing gas.
Note
The Oxygen alarm cannot be disabled during Heliox administration
Do not operate nebulizer while using heliox
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AVEA Ventilator Systems
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Chapter 2 Unpacking & Setup
Ventilator Assembly & Physical Setup
Unpacking the Ventilator
The AVEA is designed for simplicity of operation and set-up. It requires minimal assembly on site.
Items Required for Ventilator Setup
You will need the following to setup your AVEA ventilator:
Power Source. The ventilator operates from a standard 100, 110, 220, or 240 VAC power source or an optional
external 24VDC battery. There is an internal battery supplied with the ventilator, which will operate the
ventilator for short periods (see Chapter 6, Maintenance & Cleaning)
CAUTION
The ventilator should be connected to a mains AC power supply for at least 4 hours prior to switching to internal battery
power. For operation on external battery the ventilator should be connected to a mains AC power supply for at least 12
hours with green LED lot to insure a fully charged battery.
Pressurized Oxygen, Air or Heliox Gases. The compressed gas sources must provide clean, dry, medical grade
gas at a line pressure of 20 to 80 PSIG (1.4 to 5.6 bar).
Air or Heliox Supply
Pressure Range:
Temperature:
Minimum Flow:
Air Inlet fitting
Heliox Inlet fitting
20 to 80 psig (1.4 to 5.5 bar) (Supply Air)
20 to 80 psig (1.4 to 5.5 bar) (Supply Heliox - 80% / 20% Heliox Only)
3 to 10 psig (0.2 to 0.7 bar) (Compressor Air)
5 to 40°C (41 to 104°F)
80 L/min at 20 psig (1.4 bar)
CGA DISS-type body, No. 1160 (Air). NIST fitting per BS-5682:1984 (Air) also available.
CGA DISS-type body, No. 1180 (Heliox)
Note
NIST fittings for Air and Oxygen are available from VIASYS, upon request at time of order.
Oxygen Supply
Pressure Range:
Temperature:
Humidity:
Minimum Flow:
Inlet Fitting:
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20 to 80 psig (1.4 to 5.5 bar) (Supply Oxygen)
5 to 40º C (41 to 104º F)
Dew Point of gas should be 1.7º C (3º F) below the ambient temperature (minimum)
80 L/min at 20 psig (1.4 bar)
CGA DISS-type body, No. 1240. NIST fitting per BS-5682:1984 (O2) also available.
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Assembling the Ventilator
Assemble your AVEA ventilator’s wheeled base using the instructions included in the package. The ventilator body is
easily attached to the base by means of four thumbscrews. Reference Installation Instructions L2353 for detailed
directions. See figure 2.1.
Standard
Ventilator Base
Comprehensive
Ventilator Base
Figure 2.1 Basic and Comprehensive base attachment
CAUTION
The ventilator body and UIM weigh approximately 80 lbs. ( 36.4 kg) Employ safe lifting procedures when assembling the
ventilator.
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External battery option
If you have purchased the optional external battery pack, the drop
cable should be fed up the central pole of the base and out through
the cord routing well shown in figure 2.2 prior to attaching the base
to the ventilator body. Install your external batteries per the
installation instructions enclosed with the cart accessories kit (P/N
11372). Reference Installation Instructions L2353 for detailed
directions.
When the cord is in place, use the handles on each side of the
ventilator body to maneuver and align it with the thumbscrews on
the base (see figure 2.1). Tighten the thumbscrews.
Figure 2.2 External Battery Routing
Setting Up the Front of the Ventilator
Assembling the Exhalation Filter and Water Trap
To assemble and insert the exhalation filter and water trap do the following:
Screw the supplied water collection bottle
into the threaded cuff of the water trap.
Figure 2.3 Attaching the Collection Bottle to the Water Trap
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Push the exhalation filter into the water trap assembly top as shown.
Locating Ridge for assembly
into cartridge
Figure 2.4 Attaching the Exhalation Filter.
Align the locating ridge on the water trap assembly with the slot in the exhalation filter
cartridge (see fig 2.5).
Slot matches
locating ridge of
water trap
assembly
Figure 2.5 Exhalation Filter Cartridge Showing Locating Slot
Slide the water trap/exhalation filter assembly into the cartridge (see fig 2.6)
Figure 2.6 Exhalation Filter/Water Trap Assembly in Cartridge
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Rotate the metal locking lever on the lower right of the ventilator body
forward to an open position.
Figure 2.7 Open locking lever
Insert the completed cartridge assembly
into the ventilator body as shown. Make
sure it is completely seated in the well.
Figure 2.8 Insert exhalation filter
Note
Placement of the exhalation filter/water trap assembly without the exhalation filter cartridge may cause misalignment of
the filter seal resulting in patient breathing circuit leaks.
Close the locking lever.
Figure 2.9 Close locking lever in place
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Attaching the Patient Circuit
Adult Circuit using an Active
Humidifier
Using an active humidifier, the adult patient
circuit is set up as shown in figure 2.10.
Attach your humidifier to the upright pole of
the AVEA base. Adjust the height of the
humidifier and the length of the humidifier
tubing so that the tubing is relatively
straight with no occlusions.
Inspiratory
limb of Patient
Circuit
Figure 2.10 Adult Circuit with Active Humidifier
Adult Circuit without active humidifier
The setup for use with a passive humidifier or HME is
per figure 2.11. The inspiratory limb of the patient circuit
connects directly to the gas output of the ventilator. The
passive humidification system should be placed in-line
in the patient circuit per the manufacturer’s instructions.
Inspiratory Limb
of Patient Circuit
Figure 2.11 Adult Patient Circuit without active humidifier.
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Neonatal Patient Circuit
The Neonatal Patient Circuit is attached as
shown in figure 2.12.
Inspiratory Limb
of Patient Circuit
Figure 2.12 Neonatal Patient Circuit
Front Panel Connections
Standard
Comprehensive
Figure 2.13 AVEA Front Panel Configurations Standard & Comprehensive
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Attaching Flow Sensors
The AVEA can accept either a hot wire or a variable orifice proximal flow sensor. These are in addition to the
instrument’s internal inspiratory flow sensor and heated expiratory flow sensor. Three proximal flow sensors are available
for the AVEA.
The standard Hot Wire flow sensor is suitable for neonatal and pediatric applications where the peak inspiratory flow rate
is less than 30 L/min. This flow sensor is not active in adult applications.
Hot Wire Flow Sensor
A Hot Wire flow sensor attaches to the receptacle
circled in light blue directly below the variable orifice
flow sensor connection on the front panel. The
receptacle is marked with the icon shown here.
Retractable plastic
collar
This is a locking connector. To attach, first pull back
the locking collar, then push firmly onto the ventilator
receptacle.
To disconnect, first retract the plastic collar then
firmly pull the connector away from the ventilator.
Do not pull up or down as this can damage the
connector
Figure 2.14 Hot wire Flow Sensor Attachment
Note
Hot wire flow sensors will not function with Heliox gas mixtures. During Heliox delivery, a variable orifice flow sensor
should be used for monitoring delivered volumes at the proximal airway.
Variable orifice flow sensors are also available on some AVEA models. The neonatal VarFlex flow sensor is compatible
in neonatal and pediatric applications where the peak inspiratory flow rate is less than 30L/min and is not active in adult
applications. For adult and large pediatric applications a Pediatric / Adult VarFlex flow sensor is available for use with
patients whose flow requirements fall within the range of 1.2 – 180 L/min.
Detailed information on the specifications of each flow sensor can be found in Appendix E: Sensor Specifications and
Circuit Resistance.
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Variable Orifice Flow Sensor
Retractable
Plastic Collar
Variable Orifice sensors attach to the receptacle on the front panel of the
ventilator circled in dark blue and marked with the icon shown here.
This is a locking connector. To attach, first pull back the plastic locking collar,
then push firmly onto the ventilator receptacle. Then push the locking collar
forward to lock the flow sensor in place.
To disconnect, first retract the plastic collar then firmly pull the connector away
from the ventilator. Do not pull up or down as this can damage the connector.
Figure 2.15 Variable Orifice
Flow Sensor Attachment
CAUTION
Fully retract the plastic locking collar before attaching these connectors. Failure to do this can cause damage to the
connector.
Attaching a Nebulizer
You can use an in-line nebulizer with the AVEA ventilator
(see Chapter 3, Ventilator Operation). The nebulizer is
synchronized with inspiration, delivers gas at the set
FiO2/FiHe and is active for 20 minutes. Attach the
nebulizer tubing to the fitting at the bottom of the front
panel as shown here. The fitting is marked with the icon
shown here.
Figure 2.16 Attaching nebulizer tubing
Note
To use the internal nebulizer, the AVEA must be connected to a high-pressure air source. The nebulizer is not active
while the AVEA is operating on its internal compressor. The ventilator incorporates an internal pneumatic compressor,
which creates the drive pressure necessary to operate the nebulizer.
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Note
The nebulizer requires an inspiratory flow rate of at least 15 liters per minute to activate and is flow compensated to
maintain set tidal volumes.
CAUTION
When the internal nebulizer is used, the ventilator decreases the flow rate by 6 L/min to compensate for the nebulizer
output. However, since flow from the internal nebulizer can vary, using the internal nebulizer may impact the tidal
volumes delivered to the patient.
Note
Do not operate the nebulizer while using Heliox
Attaching a Proximal Pressure Sensor
A proximal pressure sensor to monitor proximal airway pressure can be attached to the Comprehensive model of AVEA.
On the Comprehensive AVEA the connector is labeled as Aux as shown in figure 2.17.
When active, this feature will display & alarm to proximal airway pressures.
Figure 2.17 Proximal pressure sensor connection on the Comprehensive AVEA
Note
In applications which generate high resistances within the breathing system monitored, Proximal Airway Pressure may
be higher than set Inspiratory Pressure.
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(Comprehensive Model Only)
Esophageal Balloon
The connection intended for an esophageal balloon is circled in
green at the top of the front panel as shown here. It is identified
with the legend PES.
Figure 2.18 Esophageal balloon connector
Note
See chapter 4 for placement technique for esophageal balloons.
Tracheal Catheter
A tracheal catheter will attach to the AVEA at the connection on the front panel marked as Aux. The connector is shown
in figure 2.18.
Note
See chapter 4 for placement technique for tracheal catheters.
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Other Connections
WARNING
The AVEA is designed to ensure that the user and patient are not exposed to excessive leakage current per
applicable standards (UL2601 and IEC60601-1). However, this cannot be guaranteed when external devices are
attached to the ventilator.
To prevent the risk of excessive enclosure leakage current from external equipment attached to the RS-232,
printer or video ports, the protective earth paths must be isolated to ensure proper connection.
This isolation should ensure that the cable shields are isolated at the peripheral end of the cable.
RS-232 Connections
The RS-232 #1 connection is used for AVEA feature upgrades, which are performed by a VIASYS certified technician
only, and communications. The communications protocol is described in document L2317 AVEA Communications
Protocol.
WARNING
The RS-232 #2 port connection is non-functional. Do not use.
Figure 2.19 Connections beneath the UIM screen
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Printer Connector
The AVEA has a standard 25 pin female Centronics parallel printer port for interfacing to an external printer.
SVGA Connector
A SVGA output connector is provided to enable real time display of the screen from a separate external display device
such as an LCD projector or remote monitor. This output can be switched on and off on the utilities screen.
Medical Information Buss (MIB) Connector
IEEE 1073 Medical Information Buss connection.
This communication port is used for all serial communication from the AVEA. Please contact your VIASYS Sales
Specialist for available applications and kits.
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Setting Up the Rear of the Ventilator
C
B
A
J
I
E
D
F
G
H
Figure 2.20 Rear panel
A – AC power module
H – Oxygen hose connection
B – UIM connection
I – External battery connector
C – Analog input/output/ILV
J – External battery fuse
D - Power ON/OFF Switch
E – Nurse call system connection
F – Air smart connector
G – Oxygen sensor
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Connecting the Oxygen Sensor
O2 Cell
The oxygen sensor cell is located on the rear panel, between the two gas fittings.
The oxygen sensor cable emerges from the rear panel directly above the sensor.
Carefully align and then gently push the connector onto the oxygen sensor until it
seats. When a good connection has been made, slide the protective cover down
and push over the sensor.
Figure 2.21 Connecting the O2 Sensor
Connecting Gas Fittings
The “Smart” Air Fitting
Collar
There are two gas connections on the rear
panel of the ventilator. The one on the left of
the panel is for attaching the Air or Heliox
gas source.
The smart connector fitting type shown here
is CGA DISS-type body No. 1160 for air with
an integral water trap/filter. To prevent the
entry of moisture into the ventilator from a
wall air source, the external water trap is
placed in-line between the air hose and the
“smart” air connector.
To attach, align the connector assembly (see
figure 2.22), seat gently onto the fitting and
screw down the fitting collar until finger tight.
“Smart” Connector
Similar connectors for Air with NIST and
Air Liquide fittings are also available from VIASYS.
Figure 2.22 Attaching the Air “smart”
connector with water trap.
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Chapter 2 Unpacking & Setup
The “Smart” Heliox Fitting
AVEA Ventilator Systems
Collar
A DISS-type, No. 1180 smart connector fitting is
also available for use with an 80/20 Heliox gas
mixture (see figure 2.23). Follow the instructions
contained with your Heliox kit to install the
tethered Heliox connector. This fitting has no
integral water trap/filter. All AVEA “Smart”
connectors with or without the integral water
trap/filter, attach in the same way. Align the
connector (see figures 2.22 and 2.23), seat gently
onto the fitting and screw down the fitting collar
until finger tight.
Tether
Figure 2.23 Attaching the Tethered Heliox Connector
The AVEA “Smart” connectors signal to the ventilator which type of fitting is attached and therefore which gas controls to
initiate.
The fitting on the right of the panel is for attaching the Oxygen gas source. The O2 fitting type is CGA DISS type, No.
1240. (NIST or Air Liquide oxygen fittings are also available from VIASYS)
Attaching the Gas Hoses
Oxygen Connection
Attach the Oxygen hose to the fitting on the right of the back panel
(see figure 2.24).
Figure 2.24 Connecting the O2 Hose
Heliox Connection
If you have the upgrade for Heliox delivery, attach the Heliox hose .to the tethered
“Smart” connector fitting on the left of the back panel as shown in figure 2.25.
The air hose will not attach to the fitting designed for Heliox and vice versa.
Figure 2.25 Connecting the Heliox Hose
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WARNING
Allow 90 seconds for the accumulator to purge before initiating patient ventilation with Heliox gas.
WARNING
Connection of a gas supply at the Helium-Oxygen mixture inlet that does not contain 20% oxygen can cause
hypoxia or death.
Although an 80/20 mixture of Helium and Oxygen is marketed as medical grade gas, the Helium/Oxygen gas
mixture is not labeled for any specific medical use.
Attaching the Air Hose
Attach the Air supply hose to the “Smart” connector fitting with the
integral water trap/filter on the left of the back panel as shown in figure
2.26.
The fitting shown here is a DISS fitting. Fittings which accept NIST
and Air Liquide hoses are also available from VIASYS.
The air hose will not attach to the fitting designed for Heliox and vice
versa.
Figure 2.26 Attaching the Air Hose to the water trap/filter
Note
The fitting for Air will not accept a Heliox connection and vice versa.
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Utilities Screens
Configuration Tab
Figure 2.27 Utilities Screen
Alarm Loudness.
To change alarm sound levels depress and hold the increase or decrease soft keys until the desired level is reached.
The “Alarm Test” banner will appear during the adjustment.
Enable / Disable O2 Alarm.
The High and Low oxygen alarms can be disabled in the event of a failure of the oxygen sensor while the ventilator is in
use. To disable the alarm depress the Enable / Disable O2 soft key, to re-enable depress the soft key again.
NOTE
The oxygen alarms cannot be disabled while heliox is in use. Powering the ventilator off and back on again will
automatically re-enable the oxygen alarms.
WARNING
Although disabling the oxygen alarms will not effect oxygen titration an external analyzer should be placed in
line in the breathing circuit until the oxygen sensor has been replaced.
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Flow Correction
Allows for flow correction to BTPS (Body Temperature Pressure Saturated or ATPD (Ambient Temperature
Pressure Dry). Default position is BTPS and should be used for all clinical applications.
ILV Mode
To enable Independent Lung Ventilation and define the Master and Slave ventilators, access the Utilities screen from the
screens menu (see figure 2.30). ILV requires the use of a specially configured accessory cable kit, which is
available from VIASYS (Part Number 16246).
With both ventilators turned off, connect the ILV cable PN 16124 to the analog port of each ventilator. Turn on the
ventilator to be designated as the “Slave”. Adjust all primary and advances settings as desired.
Next, power up the “Master” ventilator. Select “Master” from the Utilities screen. Adjust all primary and advanced settings
as desired.
Connect the patient.
Note
Ventilation will not begin until the Master ventilator has been turned on.
Each ventilator maintains independent settings for FiO2 during independent lung ventilation. Close monitoring of set
FiO2 on each ventilator is recommended.
Confirm alarm settings on each ventilator. Each ventilator will alarm independently based on alarm settings established
for that particular ventilator.
Apnea ventilation on the Slave ventilator is driven by the apnea ventilation rate of the Master ventilator only.
Should the ventilators become disconnected during ILV, only the Master ventilator will alarm for the ILV Disconnect
condition. The Slave ventilator will alarm for Apnea and begin apnea ventilation at its own active settings.
WARNING
DO NOT attempt to connect a standard DB-25 cable to this receptacle. This could cause damage to the
ventilator. A specially configured cable is required for ALL features associated with this connector. Contact
VIASYS Tech Support.
Setting up Independent Lung Ventilation (ILV)
The AVEA has a 25 pin receptacle on the rear panel (see figure 2.20) to allow for Independent Lung Ventilation (ILV)
.with another AVEA. The output for ILV provides a 5VDC logic signal synchronized to the breath phase of the master
ventilator. Table 2.3 at the end of this section details the relevant pins for the signals carried by this connector.
Note
This connector also carries the Analog Input and the Analog Output signals. Refer to Appendix B Specifications for
Analog Output Pressure (cmH2O/mv), flow ((ml/min)/mv) and Volume (ml/mv) conversions.
ILV connector pin configuration
To connect two AVEA ventilators together for independent lung ventilation function, the cable must be wired so that the
ILV input (the slave) on one AVEA is connected to the ILV output (the master) on the other AVEA. As shown in figure
2.27 below, the ILV slave is pin 18, and the ILV master is pin 6. In addition, at least one of the analog grounds (pins 5, 9,
10, 11, 12 or 13) must be connected. We recommend using a shielded cable.
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For ILV operation:
Connect an analog ground on Vent 1 to analog ground on vent 2 (See figure 2.28).
Connect Pin 6 on Vent 1(Master) to pin 18 on vent 2 (Slave).
Connect Pin 18 on Vent 1 to pin 6 on vent 2.
Slave
Master
Figure 2.28 ILV Connection Pin Configuration
Figure 2.29 Analog Ground Pins
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Note
At least one analog ground is required for safe and accurate signal output and input. One analog ground is sufficient for
any and all of the other signals.
Selecting Language .
Touch the language box and use the data dial to select the desired language. Use the Accept key to accept the change.
All text displayed on the LCD screen will automatically be translated to the set language.
Note
For ease of use all languages appear in their native text in the text selection box on the utilities screen.
Low Vte Alarm Sensitivity
Sets the number of consecutive breaths with an exhaled tidal volume below the Low Vte Alarm setting which are
required to sound the alarm. The default is 3 breaths; the range is 1-5 breaths.
Increase FiO2
Configures the step increase used during the increase oxygen maneuver. Sets the amount of oxygen the
ventilator will increase above the current set FiO2.
Example:
If the Increase FiO2 is set at 20%
AND
The set FiO2 is 40%
WHEN
The increase FiO2 Maneuver is activated the FiO2 will increase to 60% for two
minutes after which it will return to 40%.
The default setting for infants is 20% and 79% for Pediatric and Adult applications.
Note
To achieve 100% delivered FiO2 during the Increase O2 maneuver set the Increase FiO2 setting to its maximum of 79%.
Note
The settings will be reset to default values when New Patient is selected in the set up menu.
Setting the Barometric Pressure.
Using the touch turn touch technique use the data dial to set the correct barometric pressure for the current altitude.
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Note
Failure to properly set the barometric pressure can affect accuracy of some of the instruments monitoring systems. See
Appendix G for Barometric Pressure / Altitude conversion chart.
Input/Output Tab
Analog Input Configuration
Under the heading “Set Analog Input Scale” there are two buttons representing two possible voltage ranges.
If the full-scale output of the device you are interfacing with is less than 1 volt, select the 0-1 volt scale button.
If it is 5V or less, select the 0-5 volt range. Select the appropriate analog scale and press the “ACCEPT” key to enter the
configuration.
Analog Input is configured on the same connector as the ILV. The pin configuration for cables to use this feature is
shown in figure 2.29 below. Pin configuration of the connector for attachment to your other device must be supplied by
the manufacturer of that device
WARNING
All applications using this connector require specially made cables. DO NOT connect a standard DB25 cable to
this receptacle. This could result in damage to the ventilator. Contact VIASYS Respiratory Care technical
support at the numbers given in Appendix A.
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Analog Input Channel 1
Analog Input Channel 0
Figure 2.30 Analog Input connections
Analog Outputs
Set Analog Output Type
The analog output flow signal can be selected between Wye Flow (calculated flow to the patient) or Machine Flow (the
flow measured by the inspiratory flow sensor within the ventilator).
Pressure, Flow, Volume, Breath Phase
Figure 2.32 Analog Outputs Pin configuration
The pin configuration for pressure, flow, volume and breath phase analog outputs is shown above. Refer to Appendix B
Specifications for Analog Output Pressure (cmH2O/mv), flow ((L/min)/mv) and Volume (ml/mv) conversions.
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Figure 2.33 Analog Ground Pins **
Note
At least one analog ground is required for safe and accurate signal output and input. One analog ground is sufficient for
any and all of the other signals.
Table 2.3 ILV and Analog I/O pin configuration
PIN
1
FUNCTION
Analog Input Channel 0
14
Analog Input Channel 1
18
ILV In
6
ILV Out
20
Factory Use Only. DO NOT CONNECT.
22
Analog Output, PRESSURE
23
Analog Output, FLOW
24
Analog Output, VOLUME
25
Analog Output, BREATH PHASE
5, 9,10,11,12,13
Ground, Analog (see Note)
Video Output
Enables or disables the real time video output via the SVGA connector on the bottom of the UIM. Default position is off.
RS 232 Output
Sets the RS 232 output format for digital communications via the port labeled MIB.
Nurse Call Connection
The AVEA can be connected to a remote nurse call system via the modular connector on the rear panel shown in figure
2.20, E. The jack is configured to interface with normally closed (NC, open on alarm) or normally open (NO, closed on
alarm) signals. Cables for both systems are available from VIASYS Respiratory Care Inc.
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Date/Time Tab
Setting the Date.
Using the touch turn touch technique use the data dial to set the correct month, day and year prior to use of the
ventilator.
Setting the Time.
Using the touch turn touch technique use the data dial to set the correct time in hours and minutes prior to use of the
ventilator.
Note
After changing the date and/or time, cycle the ventilator off, then on and select “NEW PT” to ensure coordination of the
EVENTS and TRENDS with the new date/time set.
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Powering up the AVEA
To power up the ventilator, connect the power cord to a suitable AC power supply and turn on the power switch located
on the back panel of the ventilator as shown here.
ON
OFF
Figure 2.34 Power Switch
The power up/reboot time for this instrument is approximately 7 seconds.
WARNING
A protective ground connection by way of the grounding conductor in the power cord is essential for safe
operation. If the protective ground is lost, all conductive parts, including knobs and controls, which may appear
to be insulated, can render an electric shock. To avoid electrical shock, plug the power cord into a properly
wired receptacle, use only the power cord supplied with the ventilator, and make sure the power cord is in good
condition.
WARNING
If the integrity of the external power earth conductor arrangement is in doubt, unplug the ventilator from the
mains AC and operate it from its internal battery or the optional external battery.
User Verification Test
WARNING
The User Verification Test should always be performed off patient.
The User Verification Test consists of the three following sub-tests and should be performed before connection to a new
patient.
The POST test:
The POST or Power On Self Test is transparent to the user and will only message if the ventilator encounters
an error. Normal ventilation commences at the culmination of the POST.
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The Extended Systems Test (EST). During this test the ventilator will perform:
Patient circuit leak testing
Patient circuit compliance measurement
Two point calibration of the oxygen sensor
The Alarms Test consisting of verification for:
High Ppeak alarm
High Ppeak, Sust
Low Ve alarm
High Ve alarm
High Vt alarm
Low O2 alarm
Low Vt alarm
High O2 alarm
Low Ppeak alarm
Loss of AC alarm
Circuit Disconnect
High Rate Alarm
Apnea Interval alarm
Low PEEP alarm
CAUTION
Although failure of any of the above tests will not prevent the ventilator from functioning, it should be checked to make
sure it is operating correctly before use on a patient.
The Power on Self Test (POST)
This test is run automatically and performs the following checks:
Processor Self Check
ROM Check Sum
RAM Test
The POST will also check the audible alarms and the LEDs at which time the audible alarm sounds and the LEDs on the
User Interface Module flash. Normal ventilation commences at the culmination of the POST.
The Extended Systems Test (EST)
The EST function is accessed from the Setup screen as shown here. Press the SETUP membrane button to the lower
left of the UIM to open this screen.
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Press the EST touch screen icon to highlight.
A message will appear instructing you to remove
the patient and block the patient wye.
After confirming that the patient has been
disconnected and the circuit wye blocked press the
Continue (Cont) button.
The ventilator will perform the EST and display a
countdown clock.
During this test the ventilator will perform:
•
Patient circuit leak test
•
Patient circuit compliance measurement
•
Two point calibration of the oxygen sensor
The patient circuit compliance measurement and
leak test are performed simultaneously with the
oxygen sensor calibration. The maximum time for
the EST is 90 seconds. To restart the EST at any
time select the Cancel button to return to the set up
screen.
After each test is complete the ventilator will
display a “Passed” or “Failed” message next to the
corresponding test.
Once the test is complete press the continue
button to return to the set up screen.
The “SET UP ACCEPT” key must be pressed in order for the AVEA to retain the circuit compliance measurement. At
this point, even after power cycling off, if “SAME PT” is selected, the circuit compliance measurement will continue to be
retained. If “NEW PT” is selected, the EST will be required to use this feature.
Note
If you do not connect the ventilator to an oxygen supply, the O2 Sensor Calibration will immediately fail.
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The Alarms Test
Note:
To ensure proper calibration of the oxygen sensor, you should always perform an EST prior to conducting Manual
Alarms Testing.
WARNING
User Verification Testing should always be done off patient.
CAUTION
Following each alarm verification test, ensure that the alarm limits are reset to the recommended levels shown in this
chapter before proceeding to the next test.
Test Setup Requirements:
Air Supply Pressure
O2 Supply Pressure
AC Line Voltage
Patient Circuit
Compliance
Resistance
Adult Setting
Pediatric Setting
Neonate Setting
> 30 psig (2.1 bar)
Same
Same
> 30 psig (2.1 bar)
Same
Same
115 + 10 VAC
Same
Same
6’ (2 m) Adult
6’ (2 m) Adult
Infant
20 ml/cmH2O
20 ml/cmH2O
N/A
5 cmH20/L/sec
5 cmH20/L/sec
N/A
To perform the Alarms Test on the AVEA ventilator using default settings, complete the following steps (A table
describing the default settings for Adult, Pediatric and Neonatal patient sizes is included at the end of the Alarms Test
section).
1. Make the appropriate connections for air and O2 gas supply. Connect the power cord to an appropriate AC outlet. Attach
an appropriate size patient circuit and test lung to the ventilator.
2. Power up the ventilator and select NEW PATIENT when the Patient Select Screen appears. Accept this selection by
pressing PATIENT ACCEPT. This will enable default settings for the Manual Alarms Test.
3. Select the appropriate patient size for your test (Adult, Pediatric or Neonate) from the Patient Size Select Screen.
Accept this selection by pressing SIZE ACCEPT. Set Humidifier Active off.
4. Make any desired changes or entries to the Ventilation Setup Screen and accept these by pressing SETUP ACCEPT.
5. Press Alarm Limits button on the upper right of the user interface.
6. Verify that no alarms are active and clear the alarm indicator by pressing the alarm reset button on the upper right of the
user interface.
7. Set the % O2 control to 100%. Disconnect the Oxygen sensor from the back panel of the ventilator and verify that the
Low O2 alarm activates. Return the O2 control setting to 21% with the sensor still disconnected from the rear panel.
Remove sensor from back panel. Provide blow-by to the sensor from an external oxygen flow meter. Verify that the High
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O2 alarm activates. Return the % O2 to 21%, reconnect the Oxygen sensor to the back panel. Clear all alarm messages
by pressing the alarm reset button.
8. Set PEEP” to 0. Set Low PEEP alarm to 0. Disconnect the patient wye from the test lung. Verify that the Low Ppeak
alarm activates, followed by the Circuit Disconnect alarm. This second alarm should activate after the default setting of
20 seconds for the apnea interval has elapsed. Reconnect the test lung to the circuit clear the alarm by pressing the
reset button.
9. Disconnect the AC power cord from the wall outlet. Verify that the Loss of AC alarm activates. Reconnect the AC power
cord. Clear the alarm by pressing the reset button.
10. Occlude the exhalation exhaust port. Verify that the High Ppeak alarm activates, followed 5 seconds later by the
activation of the High Ppeak, Sust. alarm.
11. Set the control setting for rate to 1 bpm. Verify that Apnea Interval alarm activates after the default setting of 20 seconds.
Return the control setting to its default value and clear the alarm by pressing the reset button.
12. Set the Low PEEP alarm setting to a value above the default control setting for PEEP on your ventilator. Verify that the
Low PEEP alarm activates. Return the alarm setting to its default value and clear the alarm by pressing the reset button.
13. Set the High Ppeak alarm setting to a value below the measured peak pressure or in neonatal ventilation, the default
control setting for Inspiratory Pressure on your ventilator. Verify that the High Ppeak alarm activates. Return the alarm
setting to its default value and clear the alarm by pressing the reset button.
14. Set the Low Ve alarm setting to a value above the measured Ve on your ventilator. Verify that the Low Ve alarm
activates. Return the alarm setting to its default value and clear the alarm by pressing the reset button.
15. Set the High Ve alarm setting to a value below the measured Ve on your ventilator. Verify that the High Ve alarm
activates. Return the alarm setting to its default value and clear the alarm by pressing the reset button.
16. Set the High Vt alarm setting to a value below the set Vt on your ventilator. Verify that the High Vt alarm activates.
Return the alarm setting to its default value and clear the alarm by pressing the reset button.
17. Set the Low Vt alarm setting to a value above the set Vt on your ventilator. Verify that the Low Vt alarm activates. Return
the alarm setting to its default value and clear the alarm by pressing the reset button.
18. Set the High Rate alarm to a value below the default control setting for rate on your ventilator. Verify that the alarm
activates. Return the alarm to its default setting and clear the alarm by pressing the reset button.
19. Occlude the inspiratory limb of the patient circuit. Verity that the Circuit Occlusion alarm .activates.
CAUTION
Although failure of any of the above tests will not prevent the ventilator from functioning, it should be checked to make
sure it is operating correctly before use on a patient.
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Chapter 2 Unpacking & Setup
Default Settings for Adult, Pediatric and Neonate
The Default settings are the operational settings that take effect when you press the “New Patient” button on power up.
Ventilation Setup:
ET tube Diameter
ET Tube Length
Artificial Airway
Compensation
Leak
Compensation
Circuit
Compliance
Compensation
(Circ Comp)
Humidification
Patient Weight
Adult Setting
Pediatric Setting
Neonate Setting
7.5 mm
30 cm
Off
5.5 mm
26 cm
Off
3.0 mm
15 cm
Off
Off
Off
Off
0.0 ml/cmH2O
0.0 ml/cmH2O
Active On
1 kg
Active On
1 kg
Active On
1 kg
Adult Setting
Pediatric Setting
Neonate Setting
Volume A/C
12 bpm
500 ml
Volume A/C
12 bpm
100 ml
TCPL A/C
20 bpm
2.0 ml
60 L/min
15 cmH2O
20 L/min
15 cmH2O
8 L/min
15 cmH2O
0.0 sec
0.0 sec
0.0 sec
1.0 sec
0.75 sec
0.35 sec
0 cmH2O
6 cmH2O
1.0 L/min
0 cmH2O
6 cmH2O
1.0 L/min
0 cmH2O
3 cmH2O
0.5 L/min
40%
40%
40%
Adult Setting
0 (off)
5
0 (off)
1 (Dec)
2.0 L/min
3.0 cmH2O
Pediatric Setting
0 (off)
5
0 (off)
1 (Dec)
2.0 L/min
3.0 cmH2O
Neonate Setting
N/A
N/A
N/A
1 (Dec)
2.0 L/min
3.0 cmH2O
5
25%
5
25%
5
10%
0.0 ml/cmH2O
NOT active in
Neonates.
Primary Controls:
Breath Type/Mode
Breath Rate (Rate)
Tidal Volume
(Volume)
Peak Flow
Inspiratory
Pressure (Insp
Pres)
Inspiratory Pause
(Insp Pause)
Inspiratory Time
(Insp Time)
PSV
PEEP
Inspiratory Flow
Trigger (Flow
Trig)
%O2
Advanced Settings:
Vsync
Vsync Rise
Sigh
Waveform
Bias Flow
Inspiratory
Pressure Trigger
(Pres Trig)
PSV Rise
PSV Cycle
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Chapter 2 Unpacking & Setup
PSV Tmax
Machine Volume
(Mach Vol)
Volume Limit
(Vol Limit)
Inspiratory Rise
(Insp Rise)
Flow Cycle
T High PSV
T High Sync
T Low Sync
Demand Flow
AVEA Ventilator Systems
Adult Setting
5 sec
0L
Pediatric Setting
0.75 sec
0 ml
Neonate Setting
0.35 sec
0 ml
2.50 L
500 ml
300.0 ml
5
5
5
0% (off)
Off
0%
0%
On
0% (off)
Off
0%
0%
On
0% (off)
N/A
N/A
N/A
On
Adult Setting
75 bpm
3.00 L
Pediatric Setting
75 bpm
1000 ml
Neonate Setting
75 bpm
300 ml
0.0 L
0.0 ml
0.0 ml
1.0 L
0.5 L
0.5 L
30.0 L/min
30.0 L/min
5.0 L/min
8 cmH2O
8 cmH2O
5 cmH2O
40 cmH2O
40 cmH2O
30 cmH2O
3 cmH2O
20 sec
3 cmH2O
20 sec
1 cmH2O
20 sec
Alarm Settings:
High Rate
High Tidal Volume
(High Vt)
Low Tidal Volume
(Low Vt)
Low Exhaled
Minute Volume
(Low Ve)
High Exhaled
Minute Volume
(High Ve)
Low Inspiratory
Pressure (Low
Ppeak)
High Inspiratory
Pressure (High
Ppeak)
Low PEEP
Apnea Interval
Auxiliary Controls:
Manual Breath
Suction
↑ O2
Nebulizer
Inspiratory Hold (Insp
Hold)
Expiratory Hold (Exp
Hold)
Adult Setting
----79%
-----
Pediatric Setting
----79%
Neonate Setting
----20%
---
---
---
---
---
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Chapter 2 Unpacking & Setup
AVEA User Verification Test Checklist
Machine Serial Number:________________________________ Test Date: __________________
TEST
Automated Tests
Power-on self test
Patient circuit leak test
Patient circuit compliance measurement
Two point calibration of the oxygen sensor
Manual Alarms Checks
High Rate Alarm
Low Vte Alarm
High Vte Alarm
Low Ve Alarm
High Ve Alarm
Low Ppeak Alarm
High Ppeak Alarm
Low PEEP Alarm
Apnea Interval Alarm
Extended High Ppeak Alarm
Circuit Disconnect Alarm
Circuit Occlusion Alarm
Loss of AC Alarm
High O2 Alarm
Low O2 Alarm
Signature of tester:_______________________________________________
Title___________________________________________________________
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FAIL
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Chapter 2 Unpacking & Setup
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AVEA Troubleshooting
Remove ventilator from patient with any potential problem
Symptom
Problem
Solution(s)
Will not pass EST - Fails Leak
Circuit wye not fully occluded
Ensure circuit wye is fully occluded
Leak in patient circuit
Check for leaks in circuit and reseat
circuit connections to ventilator.
Replace circuit if necessary.
Filter cartridge not properly seated Remove exhalation cartridge and
check condition of connections.
Reinstall and recheck. Replace if
necessary
Leak in exhalation corner
Replace exhalation diaphragm.
Will not pass EST - Fails O2
calibration
Connector on O2 sensor not
connected properly
Inlet gas pressure too low
Check sensor connection
Internal fault
Call Technical Service
Normal Condition when operating
on test lung.
Normal if readings are within
ventilator accuracy specifications
of +/-10%
Defective expiratory flow sensor
No action required
Verify inlet air and oxygen pressure
above 20psig
Defective O2 sensor
Replace O2 Sensor
No reading from proximal flow sensor Sensor / Patient size incompatible See operators manual for correct
sensor/mode configurations
Sensor not connected
Ensure sensor properly connected
Loose external connection
Check external connection
Defective sensor
Replace sensor
Vti > Vte when operating without
proximal flow sensors
Vte > Vti
Leak in patient circuit, water
collector or exhalation system
Normal if readings are within
ventilator accuracy specifications
of +/-10%
Defective expiratory flow sensor
Leak in patient circuit, water
collector or exhalation system
Internal fault
Volume waveform above or below
baseline on patient with internal
sensor
Humidifier "Active on/off" set
incorrectly
No action required if within
specification
Clean/replace expiratory flow
sensor
Verify with leak test
No action required if within
specification
Clean/replace expiratory flow
sensor
Verify with leak test
Call Technical Service
Set for "Active on” for humidifier,
"Active off" for “HME"
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Operator’s Manual
Symptom
Volumes become inaccurate over
time
Nebulizer output absent
Problem
Solution(s)
Normal if readings are within
ventilator accuracy specifications
of +/-10%
Bad expiratory flow sensor
No action required if within
specification
Internal fault
Clean or replace expiratory flow
sensor
Call Technical Service
Foreign material on flow sensor
Clean/replace sensor
Internal fault
Call Technical Service
Ventilator running on compressor
Flow less than 15 L/min
Connect wall air
Increase flow if appropriate
Internal fault
Call Technical Service
FiO2 monitor inaccurate or reads "***" O2 sensor requires calibration
O2 sensor at end of life
PEEP too high
Exhalation filter cartridge clogged
or saturated
Defective exhalation diaphragm
Unit will not run on A/C power
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Chapter 2 Unpacking & Setup
Perform EST
Replace O2 Sensor
Replace cartridge
Change exhalation diaphragm
Blown fuse on power entry module Replace fuse
Power cord not connected to
mains power
Check connections
Unit will not run properly on battery
Battery not sufficiently charged
Improper charge level indicator Internal battery
Excessively discharged battery
Internal battery may require up to 4
hours for full charge. External
battery may require up to 12 hours
with green LED lit for a full charge.
Requires up to 4 hours for full
charge
Improper charge level indicator External battery
Excessively discharged battery
Loose connections
Decreased run time on battery
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Requires up to 12 hours for full
charge
Check connections
Battery not fully charged
Internal battery may require up to 4
hours for full charge. External
battery may require up to 12 hours
for a full charge.
Defective battery
Call technical Service
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Chapter 2 Unpacking & Setup
AVEA Ventilator Systems
Symptom
Problem
Solution(s)
Does not run on compressor
Internal fault
Call Technical Service
Auto cycling
Improper sensitivity settings
Check flow and pressure trigger
settings
Circuit leaks
Perform EST and correct leaks as
required. Bias Flow should be set to
approximately 1.5 lm greater than
Flow Trigger setting.
Turn on Demand Flow
Call Technical Service
Reduce minute volume
Insure proper connection
Vent INOP display
Low gas alarm on compressor
"Loss of gas" alarm
Device Error indicator
NCPAP Pressure Limit
Low NCPAP Pressure
High NCPAP Pressure
Circuit Disconnect
Demand Flow turned off
System fault
Minute volume exceeds 40 L/min
Air/Heliox connector not properly
connected
Internal fault
Call Technical Service
Defective sensor
Replace sensor
Exhalation flow sensor not
connected
Check connections
O2 sensor connector not
connected
Defective O2 sensor
Check O2 sensor
Replace O2 sensor
Internal fault
Call Technical Service
Improper connection sequence
External battery connection should
be made with AC power
disconnected.
Check expiratory limb for kinks
and/or water
Occlusion of expiratory limb of
patient circuit.
Occluded expiratory filter
Replace expiratory filter
Circuit disconnect
Circuit leak
Patient interface leak
Check circuit
Check patient interface
Patient circuit occlusion
Water in circuit
Patient interaction
Check patient circuit
Check nasal prongs
Patient circuit disconnect
Check patient circuit
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Chapter 3 Ventilator Operation
Membrane Buttons and LEDs
Figure 3.1a User Interface Module (International) Showing Button Icons
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Chapter 3 Ventilator Operation
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Figure 3.1b User Interface Module (English) Showing Button Labels
The Membrane buttons are the UIM controls, which surround the Touch Screen. Moving clockwise around the UIM from
the top right (see arrow), they are:
A.
Alarm Silence (LED)
Pressing this button will disable the audible portion of an alarm for 2 minutes (± 1 second) or until the Alarm Silence
button is pressed again. This button is not functional for a VENT INOP alarm.
Note
Pressing the alarm silence button will not prevent the audible alarms sounding again later for certain alarm conditions.
B.
Alarm Reset
Cancels the visual indicator for alarms that are no longer active.
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C.
Chapter 3 Ventilator Operation
3-3
Alarm Limits
Opens the alarm limits screen for data entry or adjustment. Toggles the screen on and off.
Note:
Pressing the Freeze button while the Alarm Limits window is open will automatically close the window and freeze the
graphics.
D.
Manual Breath
Pressing this button during the expiration phase of a breath delivers a single mandatory breath at current ventilator
settings. No breath is delivered if the key is pressed during inspiration.
Note
The Manual Breath button is not active in APRV / BIPHASIC.
E.
Suction (LED)
Pressing this button initiates a “Disconnect for Suction” maneuver.
The ventilator will:
Enable an “Increase % O2” maneuver for 2 minutes (see Increase O2 below).
While the circuit disconnect alarm is active, the ventilator will stop cycling and set a bias flow. The ventilator will
automatically detect the patient upon reconnection and resume normal ventilation.
Silences alarms for 120 seconds.
If the SUCTION key is pressed again during the 2 minutes that the “disconnect for suction” maneuver is active, the
maneuver will be cancelled.
F.
Increase O2
When this key is pressed, the ventilator increases the oxygen concentration delivered to the patient for 2 minutes. If the
↑ %O2 key is pressed again within this two-minute period, the maneuver is cancelled and the ventilator will return to prior
settings.
Defaults:
+20% Neonatal; 79% Adult/Pediatric
Adult/Pediatric:
79% above the set % O2
Neonate:
20% above the set % O2 or 100%, whichever is less
To configure the Increase FiO2:
Access the Configuration tab on the Utilities Screen:
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Chapter 3 Ventilator Operation
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Increase FiO2:
Configures the step increase used during the increase oxygen maneuver. Sets the amount of oxygen the ventilator will
increase above the current set FiO2.
Example:
If the Increase FiO2 is set at 20%
AND
The set FiO2 is 40%
WHEN
The increase FiO2 Maneuver is activated the FiO2 will increase to 60% for two minutes after
which it will return to 40%.
The default setting for infants is 20% and 79% for Pediatric and Adult applications.
Note
The settings will be reset to default values when New Patient is selected in the setup
Note
To achieve 100% delivered FiO2 during the Increase O2 maneuver set the Increase FiO2 setting to its maximum of
79%.
WARNING
Heliox delivery will be interrupted for the time that either the “Suction” or the “Increase O2” buttons are pressed
during administration of Heliox. Tidal volume may be affected after the 2-minute “timeout” period, or when the
button is pressed, until the accumulator has been purged.
G. Data dial
Changes the values for a selected field on the touch screen.
H. Accept
Accepts data entered into a field on the touch screen.
I. Cancel
Cancels data entered into a field on the touch screen. The ventilator will continue to ventilate at current settings.
J. Expiratory Hold
When the EXP HOLD button is pressed, at the start of the next breath interval the ventilator will not allow the patient to
inspire or exhale for a maximum of 20 seconds (adult/pediatric) or 3 seconds (neonate). Expiratory Hold is NOT active
in TCPL breaths.
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Chapter 3 Ventilator Operation
3-5
Inspiratory Hold (Manual)
When the INSP HOLD button is pressed, once the preset of a volume control or pressure control breath has been
delivered, the patient will not be allowed to exhale for a maximum of 3.0 seconds (± 0.1 second).
L. Nebulizer
The ventilator supplies blended gas to the nebulizer port at 10 ± 1.5 psig (0.7 bar) when an in-line nebulizer is attached
and the Nebulizer key is pressed, provided that the calculated delivered flow is >15 L/min.
Delivery of the nebulized gas is synchronized with the inspiratory phase of a breath and lasts for 20 minutes. Press the
Nebulizer key a second time to end the treatment prior to the end of the 20-minute period.
CAUTION
Use of an external flow source to power the nebulizer is not recommended.
WARNING
Using the nebulizer may impact delivered tidal volumes.
Note
Do not operate the nebulizer while using heliox
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M.
Chapter 3 Ventilator Operation
AVEA Ventilator Systems
Patient Size
The Patient Size Indicators for Adult, Pediatric, and Neonate at the bottom of the UIM show which
patient size is currently selected. These LED indicators have no associated membrane button on the
UIM.
Note
The ventilator will not allow patient size changes when the active mode of ventilation is not available in the new patient
size selection. The ventilator will display a message instructing you to first change the ventilation mode. For example, in
neonatal ventilation with TCPL active, you cannot change to a pediatric or adult patient size without first changing the
mode to one available for those patients.
The ventilator will also not allow size changes if Machine Volume is active. A message displays indicating that Machine
Volume must first be turned off before making a patient size change.
N.
Panel Lock (LED)
The LOCK key disables all front panel and screen controls except MANUAL BREATH, Suction,↑ %O2, ALARM RESET,
ALARM SILENCE, and LOCK.
O.
Print
The PRINT key outputs the contents of the currently displayed screen to a suitably connected parallel printer.
P.
Set-up
Opens the ventilator Setup screen.
Note
Pressing the Set-Up button a second time before accepting Set-Up will close the window and restore the previous
settings. The Set-Up screen uses an on screen accept button. To change patient size without selecting new patient
requires that patient Set-Up be accepted after selecting patient size.
Q.
Advanced Settings (LED)
Opens the Advanced Settings screen for data entry or adjustment. Toggles the screen on & off.
Note
Pressing the Freeze button while the Advanced Setting window is open will automatically close the window and freeze
the graphics.
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Chapter 3 Ventilator Operation
Mode
Opens the Mode Select screen for data entry or adjustment toggles the screen on or off. Pressing the Mode indicator at
the top of the touch screen will also access the screen.
Note
Pressing the Mode button a second time before accepting the Mode will close the window and restore the previous
settings. The Mode screen uses an on screen accept button.
S.
Event
Records an event for future reference. Some Events are recorded automatically others can be logged manually to
display in this screen. See Chapter 4, Monitors and Displays, for a full list of Events.
T. Freeze
The FREEZE key freezes the current screen and suspends real-time update of screen data until pressed again. While
the screen is frozen, a scrollable cursor appears. The Data Dial can be used to scroll the cursor through data points on
waveform, loop or trend screens. To restore the screen to active press the Freeze button a second time.
Figure 3.2 shows a flow/volume loop in “freeze” mode. The cursors trace the “frozen” loop curve along an X-Y plot line.
The values along the curve of the loop are displayed as shown below.
Flag showing X
and Y values at
various points
along the loop
tracing
Dashed
Cursor Line
Flow/Volume
Loop Tracing
Cursor, currently
overlays the “X”
axis at Zero
Figure 3.2 Flow/Volume Loop in Freeze Mode
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U.
Chapter 3 Ventilator Operation
AVEA Ventilator Systems
Screens
Opens the Screen Selection box. See figure 3.3. You can also open this by pressing the Screen indicator in the top
center of the touch screen.
Note
Pressing the Screens button a second time closes the window.
Figure 3.3 Screens Selection Box.
V.
Main
Returns the display to the main screen.
W. Alarm Status LEDs
The Alarm status indicators at the top right of the UIM flash red or yellow to indicate a high or medium priority alarm (See
chapter 5 Alarms and Indicators).
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Chapter 3 Ventilator Operation
Patient Setup
Patient Select Screen
The Patient Select screen allows you to choose to resume ventilation
of the current patient (RESUME CURRENT) or select (NEW
PATIENT) to reconfigure ventilator settings.
Figure 3.4 Patient Select Screen
If you press the Resume Current key, the ventilator begins ventilation at the most recent patient settings.
The New Patient key clears loops and trend buffers and resets all settings to default values.
Press Patient Accept to accept your selection.
Patient Size Select Screen
The Patient Size Select screen appears as the first step of the new
patient setup sequence.
Press the Size Accept button to accept your choices. The ventilator
Setup screen is revealed as the Patient Size Select screen closes (see
Fig. 3.5).
Note
The new patient size selection will not be active until the on screen
SETUP ACCEPT button is pressed.
Figure 3.5 Patient Size Selection Screen
Note
The ventilator will not allow patient size changes when the active mode of ventilation is not available in the new patient
size selection. The ventilator will display a message instructing you to first change the ventilation mode. For example, in
neonatal ventilation with TCPL active, you cannot change to a pediatric or adult patient size without first changing the
mode to one available for those patients.
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Chapter 3 Ventilator Operation
AVEA Ventilator Systems
Ventilation Setup
Ventilation Setup Screen
Figure 3.6 Ventilation Setup
In the Setup screen, controls are available to set the following:
Artificial Airway Compensation (AAC)
Range
ON/OFF
Default:
OFF
When Artificial Airway Compensation is turned on, the ventilator automatically calculates the pressure drop across the
endotracheal tube and adjusts the airway pressure to deliver the set inspiratory pressure to the distal (carina) end of the
endotracheal tube. This calculation takes into account flow, gas composition (Heliox or Nitrogen/Oxygen), Fraction of
Inspired Oxygen (FiO2), tube diameter, length, and pharyngeal curvature based on patient size (Neonatal, Pediatric,
Adult). This compensation only occurs during inspiration. Artificial Airway Compensation is active in all Pressure
Support and Flow Cycled Pressure Control Breaths.
Note:
Monitored airway pressures (inspiratory) will be higher than set values when Artificial Airway Compensation is active.
WARNING
Activation of Artificial Airway Compensation while ventilating a patient will cause a sudden increase in the peak
airway pressures and a resultant increase in tidal volume. Exercise caution when activating Artificial Airway
Compensation while the patient is attached to the ventilator to minimize the risk of excessive tidal volume
delivery.
Even if inspiratory pressure is set at zero, Artificial Airway Compensation will still provide an elevated airway pressure to
compensate for the resistance of the endotracheal tube.
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Chapter 3 Ventilator Operation
3-11
When turned on, the Artificial Airway Compensation (AAC) indicator will appear on the touch screen in all modes of
ventilation, even though Artificial Airway Compensation may not be active in the current mode (i.e. in volume controlled
breaths). This is to alert you to the fact that Artificial Airway Compensation is turned on and will become active if a
Pressure Support mode or a combination mode (i.e.: Volume Control SIMV) is selected.
Tube Diameter:
Range:
Default:
2.0 to 10.0 mm
7.5 mm
5.5 mm
3.0 mm
(Adult)
(Pediatric)
(Neonate)
Range:
2.0 to 30.0 cm
2.0 to 26.0 cm
2.0 to 15.0 cm
(Adult)
(Pediatric)
(Neonate)
Default:
30.0 cm
26.0 cm
15.0 cm
(Adult)
(Pediatric)
(Neonate)
Tube length:
Leak Compensation (LEAK COMP)
Range
ON/OFF.
Default:
OFF
During exhalation, PEEP is maintained by the cooperation of the Flow Control Valve (FCV) and the Exhalation Valve
(ExV). The ExV pressure servo is set to a target pressure of PEEP and the FCV pressure servo is set to a pressure
target of PEEP - 0.4 cmH2O. The ExV servo relieves when the pressure is above its target and the FCV supplies flow
when the pressure drops below its target up to a maximum flow rate for the patient size. It is not active during breath
delivery.
Circuit Compliance
When Circuit Compliance is active, the volume of gas delivered during a volume controlled or targeted breath is
increased to include the set volume plus the volume lost due to the compliance effect of the circuit.
Exhaled volume monitors, are adjusted for the compliance compensation volume in all modes of
ventilation.
Range:
0.0 to 7.5 ml/cmH2O
Default:
0.0 ml/cmH2O
Circuit compliance can be measured automatically by the ventilator during an Extended Systems Test (EST) or entered
manually.
Note
Circuit Compliance is active for set Tidal Volume in volume control ventilation, Target Tidal Volume in PRVC and
Machine Volume in Adult and Pediatric applications only. Although circuit compliance is displayed on the set up
screen it is not active for neonatal patients.
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Chapter 3 Ventilator Operation
AVEA Ventilator Systems
Humidifier
You can select active or passive humidification (ON/active or OFF/passive). Active humidification assumes 99% RH;
passive assumes 60% RH when using an HME. This feature adjusts the BTPS correction factor to correct exhaled tidal
volumes.
Range: Active ON/OFF
Default: Active ON
Note:
Incorrect setting of the Humidification feature will affect monitored exhaled volume accuracy
Patient Weight
Patient Weight can be set in the following ranges.
Adult
Pediatric
Neonate
1 to 300 Kg
1 to 75 Kg
0.1 to 16 Kg
Default:
1 Kg
Patient weight is a variable determined by the clinician and is used for the purpose of displaying monitored volume per
unit weight.
Identification
Patient ID. You may input a 24-character (two x 12-character), alphanumeric patient identification. To create a patient
ID, press the Touch Screen directly over the Patient IDENTIFICATION field.
A secondary screen appears showing the characters available for patient identification. Turn the data dial at the bottom
of the UIM (see figure 3.7) to scroll through the
characters. Press the ACCEPT membrane key to
accept each character and build your Patient ID
code. When the Patient ID code is complete, once
again press the Touch Screen directly over the
Patient IDENTIFICATION field to accept the entire
Patient ID code.
Check the rest of the screen parameters and if you
are satisfied with the setup, press the SETUP ACCEPT button.
Figure 3.7 Data Dial, Accept & Cancel Button
Note
Primary breath controls active for the selected (highlighted) mode are visible at the bottom of the touch screen during
setup. The Advanced Settings dialog box and the Alarm Limits dialog box can also be opened during setup. All controls
are active and may be modified while in the Set Up screen.
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EST (Extended Systems Test)
From the Setup screen, press the EST button.
A message will appear instructing you to remove the
patient and block the patient wye. After confirming that
the patient is disconnected and the circuit wye blocked,
press Continue (Cont).
The ventilator begins the EST and displays a countdown
clock. During the EST the ventilator will perform:
A Patient circuit leak test.
A Patient circuit compliance measurement.
A two point calibration of the oxygen sensor
The patient circuit compliance measurement and leak
test are performed simultaneously with the oxygen
sensor calibration. The maximum time for the EST is 90
seconds. To restart the EST at any time, press Cancel to
return to the set up screen.
After each test is complete the ventilator will display a
“Passed” or “Failed” message next to the corresponding
test.
The “SET UP ACCEPT” key must be pressed in order for
the AVEA to retain the circuit compliance measurement.
At this point, even after power cycling off, if “SAME PT” is
selected, the circuit compliance measurement will
continue to be retained. If “NEW PT” is selected, the
EST will be required to use this feature.
Figure 3.8 Extended Systems Test Screens
Once the test is complete, press Continue to return to the set up screen.
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Note:
If the ventilator is NOT connected to an oxygen supply the O2 Sensor Calibration will immediately fail.
CAUTION
Although failure of any of the above tests will not prevent the ventilator from functioning, it should be checked to make
sure it is operating correctly before use on a patient.
Setting the Ventilation Breath Type and Mode
To access the Mode selection options, press the Mode membrane button to the left of the LCD screen.
Figure 3.9 Adult and Pediatric Mode Select Screen
Figure 3.10 Infant Mode Select Screen
The choices displayed in the Mode Select screen are a combination of breath type and ventilation delivery mode (e.g. a
Volume limited breath with Assist /Control ventilation is shown as Volume A/C). APNEA Backup ventilation choices
appear when CPAP/PSV or APRV / BIPHASIC mode is selected. Apnea Backup is active in all Assist Control, SIMV,
APRV / BIPHASIC and CPAP/PSV modes.
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Note
When CPAP/PSV or APRV / BIPHASIC (Airway Pressure Release Ventilation) is selected, you MUST
1. Set the primary and advanced settings for CPAP/PSV or APRV / BIPHASIC
2
3
Select the breath type for APNEA backup mode by pressing the Apnea Settings key
Set the primary and advanced controls visible at the bottom of the touch screen, for the selected apnea breath type
before pressing the MODE ACCEPT button. The controls for the apnea breath type will not be visible once the
MODE ACCEPT button has been pressed. Only those controls that are active and required for CPAP/PSV or APRV
/ BIPHASIC will remain. To review the Apnea backup settings press the Mode button at any time and select APNEA
Settings.
Breath Types
This section contains a brief description of the breath types and ventilation mode combinations available for adult,
pediatric and neonatal patients.
There are two basic breath types:
Mandatory breaths (delivered according to set ventilator parameters)
and
Demand breaths (triggered by the patient)
All breaths are defined by four variables:
Trigger (initiates the breath),
Control (controls the delivery),
Cycle (primary breath termination), and
Limit (secondary breath termination).
Mandatory Breaths
Mandatory breaths can be triggered by the machine, the patient, or the operator. There are 4 mandatory breath types
delivered by the AVEA.
1. Volume breaths, which are:
•
•
•
Controlled by flow (inspiratory);
Limited by pre-set volume or maximum inspiratory pressure.
Cycled by volume, flow, and time.
Note.
The Volume Controlled breath is the default breath type for adult and pediatric patients.
The Intra-Breath Demand System in Volume Ventilation
AVEA features a unique intra-breath demand system in Volume Controlled ventilation, designed to provide
additional flow to the patient during periods of demand. AVEA measures the Peak Inspiratory Pressure (Ppeak)
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every 2 milliseconds throughout the breath cycle and sets a “virtual” Pressure Support Target of the greater of:
PEEP + 2 cmH2O or Ppeak – 2 cmH2O.
The minimum “virtual” Pressure Support level is set PEEP + 2 cmH2O.
The maximum is 2 times the set PEEP.
Simultaneously, the ventilator monitors and compares the Ppeak measurement to its previous value. Should the
Ppeak decrease by the 2 cmH2O, the ventilator will recognize the patient demand and automatically “switch over” to
deliver a Pressure Support breath at the virtual Pressure Support Target. This allows flow to exceed the set Peak
Flow, thereby meeting the patient’s demand.
Once the set tidal volume has been delivered, the ventilator “looks” at the inspiratory flow. If the Peak Inspiratory
Flow is greater than set peak flow, the ventilator determines that the patient is continuing to demand flow and cycles
the breath when inspiratory flow falls to 25% of peak inspiratory flow. If the Peak inspiratory Flow is equal to the set
flow, the ventilator determines that there is no continued patient demand and ends the breath as a Volume Control
breath.
Default is on. Can be turned off by accessing advanced setting of Peak Flow in Volume Controlled Ventilation.
2. Pressure breaths, which are:
•
•
•
Controlled by pressure (inspiratory + PEEP);
Limited by pressure (inspiratory + PEEP + margin);
Cycled by time or flow.
3. Time Cycled Pressure Limited (TCPL) breaths (available for neonatal patients only), which are:
•
•
•
Controlled by inspiratory flow;
Limited by pressure (inspiratory + PEEP);
Cycled by time, flow (inspiratory), or volume (Volume Limit).
Note
TCPL breath type is only available for Neonates. This is the default breath type for neonate patients.
Note
The ventilator will not allow the operator to set a Peak Inspiratory Pressure (Insp Pres or PSV + PEEP, or baseline
pressure in APRV / BiPhasic, greater than 90 cmH2O). The ventilator will deliver an on screen Pop-Up Message stating
that the Ppeak > 90 cmH2O. The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak
to less than or equal to 90 cmH2O.
WARNING
Total resistance of the inspiratory and expiratory limbs of the breathing circuit with accessories should not
exceed 4cmH2O at 5 L/min if inspiratory flows > 15 liters per minute are used in TCPL ventilation modes. For
instructions on how to perform a circuit resistance test see Appendix E.
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4. Pressure Regulated Volume Control (PRVC) breaths are pressure breaths where the pressure level is
automatically modulated to achieve a preset volume. PRVC breaths are:
•
•
•
Controlled by pressure (inspiratory + PEEP) and volume;
Limited by pressure (inspiratory + PEEP + margin);
Cycled by time or flow.
PRVC breath operation is as follows:
When PRVC is selected, a decelerating flow, volume controlled test breath, to the set tidal volume with a 40 msec
pause, is delivered to the patient. The demand system is active during this test breath.
The ventilator sets the target pressure at the end inspiratory pressure of the test breath for the first pressure control
breath.
The next breath and all subsequent breaths are delivered as pressure control breaths. The inspiratory pressure is
based on the dynamic compliance of the previous breath and the set tidal volume.
Inspiratory pressure is adjusted automatically by the ventilator to maintain the target volume. The maximum step
change between two consecutive breaths is 3 centimeters of water pressure. The maximum tidal volume delivered
in a single breath is determined by the Volume Limit setting.
The test breath sequence is initiated when any of the following occur:
Entering the Mode (PRVC)
Changing the set tidal volume while in PRVC
Reaching the Volume Limit setting
Delivered tidal volume > 1.5 times the set volume
Flow termination of the test breath
Exiting Standby
Activation of any of the following alarms
High Peak Pressure Alarm
Low Peak Pressure Alarm
Low PEEP Alarm
Patient Circuit Disconnect Alarm
I-Time Limit
I:E Limit
Note
If flow cycling is active during a PRVC or Vsync breath flow cycling of the breath can only occur if the target tidal volume
has been delivered. This allows for expiratory synchrony while assuring delivered tidal volume.
Note
Demand Flow is active for all mandatory breaths. The maximum peak inspiratory pressure achievable by the
ventilator is limited by the high peak pressure alarm setting.
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Demand Breaths
All demand breaths are patient-triggered, controlled by pressure, and flow or time cycled. Demand breaths can be either
pressure supported (PSV) or spontaneous. All demand breaths are accompanied by the yellow patient demand
indicator, which flashes in the upper left of the screen.
1.
PSV (Pressure Support Ventilation)
A PSV breath is a demand breath in which the pressure level during inspiration is a preset PSV level plus PEEP.
The minimum pressure support level is PEEP + 2 cmH2O in adult and pediatric applications, independent of the set
PSV pressure level. In neonatal applications the minimum pressure support level is zero.
PSV breaths are:
•
•
•
Controlled by pressure (preset PSV level + PEEP);
Limited by pressure (preset PSV level + PEEP)
Cycled by time (PSV Tmax) or flow (PSV Cycle).
Pressure Support is active when CPAP/PSV, SIMV or APRV/BiPhasic modes are selected
Note
The ventilator will not allow the operator to set a Peak Inspiratory Pressure (Insp Pres or PSV + PEEP, or baseline
pressure in APRV / BiPhasic, greater than 90 cmH2O). The ventilator will deliver an on screen Pop-Up Message stating
that the Ppeak > 90 cmH2O. The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak
to less than or equal to 90 cmH2O.
2.
Spontaneous breath
In adult and pediatric applications, a Spontaneous breath is a demand breath where the pressure level during
inspiration is preset at PEEP + 2 cmH2O.
In neonatal applications a Spontaneous breath is a demand breath delivered only at the preset PEEP.
Note
IF PSV level is insufficient to meet patient demand, premature termination of the breath may occur with auto-cycling. In
these cases the PSV level should be increased slightly.
Figure 3.11 PSV Waveform
In figure 3.11breath number 1 represents the flow tracing which occurs when the PSV level is insufficient to meet the
patient demand. Breath two shows resolution after increasing the PSV level slightly. (Pressure tracing will show a similar
appearance).
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Ventilation Modes
Leak Compensation.
The ventilator incorporates a leak compensation system. This system compensates for baseline leaks at the patient interface. To activate leak compensation, use the touch screen control displayed in the Setup screen.
Assist Control Ventilation (A/C)
This is the default mode for all patient types. In Assist Control ventilation mode, all breaths initiated and delivered are
mandatory breaths. The initiation of a breath is triggered by one of the following:
•
•
•
Patient effort activates the inspiratory trigger mechanism,
The breath interval, as set by the RATE control, times out,
The operator presses the MANUAL BREATH key.
Initiation of a breath by any means resets the breath interval timing mechanism. It is possible for the patient to initiate
every breath if he/she is breathing faster than the preset breath rate. If the patient is not actively breathing, the ventilator
automatically delivers breaths at the preset interval (set breath rate).
Breath Interval
elapsed
PRESSURE
Breath Interval
elapsed
TIME
1
Mandatory Breath (Breath interval expired)
2
Mandatory Breath (Patient triggered)
Figure 3.12 Assist Control Ventilation Waveform
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Synchronized Intermittent Mandatory Ventilation (SIMV)
In SIMV mode, the ventilator can deliver both mandatory and demand breath types. Mandatory breaths are delivered
when the SIMV “time window” is open and one of the following occurs:
A patient effort is detected;
The breath interval has elapsed with no patient effort detected;
Pressure
The MANUAL BREATH key has been pressed.
Time
Assist Window Open
Patient triggered Volume breath
Pressure supported breath
Figure 3.13 SIMV Waveform
The breath interval is established by the preset breath rate. It resets as soon as the interval time determined by the set
breath rate has elapsed, or when the MANUAL BREATH key is pressed.
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Airway Pressure Release Ventilation (APRV / BIPHASIC)
APRV / BiPhasic is a Time Cycled Pressure mode in which the ventilator cycles between two different baseline
pressures based on time, which can be synchronized with patient effort. Controlled ventilation can be maintained by
timed cycling the transitions between baseline pressures. Additionally, pressure support can be added to improve
comfort for the spontaneous breathing patient.
In this mode, the patient is allowed to breathe spontaneously at two preset pressure levels. These are set using the
Pres High and Pres Low controls. The maximum duration at each pressure during time cycling is set with the Time
High and Time Low controls.
The operator can also adjust the length of the respective trigger (Sync) windows with the Time High and Time Low Sync
controls, which are advanced settings of Time High and Time Low. The Sync windows are adjustable from 0 to 50%, in
5% increments of set Time High and Time Low.
The ventilator synchronizes the change from Pressure Low to Pressure High with the detection of inspiratory flow or the
first inspiratory effort detected within the T Low Sync window. Transition from Pressure High to Pressure Low occurs
with the first end of inspiration detected after the T High Sync window opens.
Note
Time High and Time Low are maximum time settings for a time-cycled transition. Actual times may vary depending on
the patient’s spontaneous breathing pattern and the Sync window setting.
Setting the Sync to 0% cycles the transition between pressure levels on time only and will not provide synchronization
with patient efforts.
The Manual Breath button is not active in APRV / BiPhasic.
The monitored PEEP in APRV/BIPHASIC is relative to the breath type. In the absence of spontaneous breathing, the
monitored PEEP will be the Pressure Low. In the presence of spontaneous breathing the monitored PEEP will reflect the
baseline pressure over which spontaneous breathing is occurred.
Adjustable PSV in APRV / BiPhasic
APRV / BiPhasic features adjustable PSV. The PSV is delivered above the current phase baseline pressure. PSV
breaths are available during Time High also, by activating T High PSV (an advanced setting of Time High). If T High
PSV is activated, during Time High, the ventilator will deliver the same PSV level for both Pressure Low and Pressure
High.
Note
The ventilator will not allow the operator to set a Peak Inspiratory Pressure (Insp Pres or PSV + PEEP, or baseline
pressure in APRV / BiPhasic, greater than 90 cmH2O). The ventilator will deliver an on screen Pop-Up Message stating
that the Ppeak > 90 cmH2O. The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak
to less than or equal to 90 cmH2O.
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Apnea Ventilation in APRV / BiPhasic
Apnea ventilation is available in APRV / BiPhasic. If the patient does not initiate a spontaneous effort, or the ventilator
does not time cycle between pressure levels before the apnea interval has elapsed, the ventilator will alarm for apnea
and begin apnea ventilation at the apnea ventilation settings. A spontaneous effort from the patient or a transition in
baseline pressure will reset the apnea alarm and timer and return the ventilator to APRV / BiPhasic ventilation.
Airway Pressure Release Ventilation
(APRV / BIPHASIC)
Pressure
Time High
Pressure High
Time Low
Pressure Low
Time
Demand Breath
Spontaneous Breath triggers change to Pressure High
Spontaneous Breath triggers change to Pressure Low
Figure 3.14 APRV / BIPHASIC Mode
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Pressure
Continuous Positive Airway Pressure (CPAP) Pressure Support Ventilation (PSV)
Time
Demand Breath
Figure 3.15 CPAP Waveform
In CPAP/PSV mode, all breaths are patient-initiated demand breaths unless the MANUAL BREATH key is pressed or
apnea backup ventilation is activated. When the MANUAL BREATH key is pressed, a single breath is delivered at the
currently selected apnea backup control settings.
Pressure Support is active in CPAP mode (see Demand Breaths in this Chapter).
CAUTION
When CPAP/PSV is selected, you must
1. Select the breath type for APNEA backup mode AND
2. Set the primary controls visible at the bottom of the touch screen, for the selected apnea breath type before pressing
the MODE ACCEPT button. The controls for the apnea breath type will not be visible once the MODE
ACCEPT button has been pressed. Only those controls that are active and required for CPAP/PSV will remain.
To review the settings for Apnea backup ventilation open the mode window, and select Apnea Settings
Note
IF PSV level is insufficient to meet patient demand, premature termination of the breath may occur with auto-cycling. In
these cases the PSV level should be increased slightly.
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Figure 3.16 PSV Waveform
In figure 3.16 breath number 1 represents the flow tracing which occurs when the PSV level is insufficient to meet the
patient demand. Breath two shows resolution after increasing the PSV level slightly. (Pressure tracing will show a similar
appearance).
Non-Invasive Ventilation
The ventilator can perform non-invasive ventilation with a standard dual limb circuit. Leak compensation should be
turned on when using this feature. To turn leak compensation on, use the touch screen control displayed in the Ventilator
Set-Up Screen.
NOTE
Non invasive ventilation requires the use of a snug fitting mask with no bleed holes. Excessive leaks around the mask
may result in false triggering of the ventilator or assertion of disconnect alarms.
Apnea Backup Ventilation
Apnea Backup Ventilation is available in Assist Control, SIMV, CPAP/PSV and APRV / BIPHASIC modes.
Apnea Backup in Assist Control or SIMV
When in Assist Control or SIMV modes, the apnea backup rate is determined by the operator-set mandatory breath Rate
or the Apnea Interval setting (whichever provides the highest respiratory rate).
When the Apnea Interval setting (found in the Alarm Limits window) determines the backup rate, the ventilator will
continue to ventilate at this rate until the apnea has been resolved.
All other controls for apnea ventilation in Assist Control and SIMV are set when the primary control values for these
modes are selected.
Apnea ventilation will terminate when one of the following criteria are met:
•
The patient initiates a spontaneous breath
•
A manual breath is delivered
•
The mandatory respiratory rate is increased above the apnea interval setting.
NOTE
The apnea interval timer is suspended during a Patient Circuit Disconnect Alarm.
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Apnea Backup in CPAP/PSV or APRV / BIPHASIC
When CPAP/PSV or APRV / BIPHASIC is selected, you MUST:
1. Set the primary and advanced settings for CPAP/PSV or APRV / BIPHASIC and
2. Select the breath type for APNEA backup mode (Volume or Pressure in adult and pediatric patients or
Volume, Pressure or TCPL in neonatal patients) by pressing the Apnea Settings key.
3. Set the primary and advanced controls appearing at the bottom of the touch screen, for the selected apnea
breath type before pressing the MODE ACCEPT button. The controls for apnea backup ventilation will
not be visible once the MODE ACCEPT button has been pressed. Only the controls that are active
and required for CPAP/PSV or APRV / BIPHASIC will remain.
See figures 3.17 to 3.20 for Apnea backup settings available in each mode.
Figure 3.17 Volume Apnea Backup Settings for APRV / BIPHASIC mode
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Figure 3.18 Pressure Apnea Backup setting for APRV / BIPHASIC Mode
Figure 3.19 Volume Apnea Backup settings for CPAP Mode
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Figure 3.20 Pressure Apnea Backup settings for CPAP mode
Apnea ventilation will terminate when one of the following criteria are met:
•
The patient initiates a spontaneous breath
•
A manual breath is delivered
•
A timed transition between baseline pressures in APRV / BiPhasic
To review the Apnea backup settings press the Mode button at any time and select APNEA Settings.
Note
When changing from a controlled mode of ventilation to CPAP/PSV or APRV / BIPHASIC, the default apnea settings will
be the same as those set in the controlled mode. If a New Patient is selected, the default apnea settings are the same
as the factory set default settings for each of the controlled modes.
Note
The current set FiO2 is delivered during Apnea ventilation.
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Standby
To initiate Standby, press the Screens membrane button on the UIM identified by the icon shown here.
The Screen Select box will display, see figure 3.21.
Figure 3.21 Screen selection
Press STANDBY. The following message will display
Figure 3.22 Standby Message
If you select “YES”, the ventilator will stop ventilating, the safety valve will close and the ventilator will supply 2 L/min of
gas continuously to the patient circuit and will display the message shown in figure 3.22.
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Figure 3.23 Standby Screen
To resume patient ventilation, press the Resume button. The ventilator will restart ventilation at the most recent settings.
Do not re-connect the patient to the ventilator until the RESUME button has been pressed and ventilation has restarted.
CAUTION
The 2 liters of bias flow, which is maintained during standby, is intended to reduce the risk of circuit overheating in the
event an active humidifier is in use and left on.
To ensure flow through the entire ventilator circuit, the patient wye should be plugged to direct flow down the expiratory
limb of the circuit. Failure to do this may result in damage to the ventilator circuit if the humidifier is left on. Consult the
circuit manufacturer to confirm that 2 L/min of flow is sufficient to prevent overheating.
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Available Breath Types & Modes by Patient Size
Adult and Pediatric Ventilation Modes
The following breath types & ventilation modes are available for Adult and Pediatric patients. When a mode is selected,
its description is displayed at the top left of the touch screen.
Table 3.1 Adult and Pediatric Displayed Modes
Displayed Mode
Volume A/C
Pressure A/C
Volume SIMV
Pressure SIMV
CPAP / PSV
PRVC A/C
PRVC SIMV
APRV /
BIPHASIC
Description
Volume breath with Assist ventilation (Default for adult and pediatric patients)
Pressure breath with Assist ventilation
Volume breath with Synchronized Intermittent Mandatory Ventilation (SIMV) and an adjustable level
of pressure support for spontaneous breaths.
Pressure Breath with Synchronized Intermittent Mandatory Ventilation (SIMV) and an adjustable level
of pressure support for spontaneous breaths.
Continuous Positive Airway Pressure (Demand Breath) with Pressure Support Ventilation
Pressure Regulated Volume Controlled breath with Assist Ventilation
Pressure Regulated Volume Controlled breath with Synchronized Intermittent Mandatory Ventilation
(SIMV) and an adjustable level of pressure support for spontaneous breaths.
Spontaneous demand breath at two alternating baseline pressure levels or controlled ventilation
cycled by time.
Neonatal Ventilation Modes
The following table shows the breath types and ventilation modes available for Neonatal patients
Table 3.2 Neonatal Displayed Modes
Displayed Mode
Volume A/C
Pressure A/C
Volume SIMV
Pressure SIMV
Description
Volume breath with Assist ventilation (Default for adult and pediatric patients)
Pressure breath with Assist ventilation
Volume breath with Synchronized Intermittent Mandatory Ventilation (SIMV) and an adjustable level
of pressure support for spontaneous breaths.
Pressure Breath with Synchronized Intermittent Mandatory Ventilation (SIMV) and an adjustable level
of pressure support for spontaneous breaths.
TCPL A/C
TCPL SIMV
Time Cycled Pressure Limited breath with Assist ventilation (Default for neonatal patients)
CPAP / PSV
Continuous Positive Airway Pressure (Demand Breath) with Pressure Support Ventilation
Time Cycled Pressure Limited breath with SIMV and an adjustable level of pressure support for
spontaneous breaths.
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Primary Breath Controls
The Primary Breath Controls are the operator set controls, which directly affect the way a breath is delivered to your
patient. They are displayed along the bottom of the AVEA LCD touch screen. Only the active controls for the selected
mode of ventilation will be displayed.
Table 3.3 Primary Breath Controls
Displayed
Control
Description
Range
Accuracy
Breath rate shown in Breaths
per Minute
1 to 150 bpm (Neo / Pediatric)
1 to 120 bpm (Adult)
± 1 bpm
Tidal Volume in milliliters
0.10 to 2.50 L (Adult)
25 to 500 ml (Pediatric)
2.0 to 300 ml (Neonate)
± (0.2 ml + 10% of setting)
cmH2O
Insp Pres
Inspiratory Pressure in
centimeters of water pressure
0 to 90 cmH2O (Adult/Pediatric)
0 to 80 cmH2O (Neonate)
± 3 cmH2O or ± 10% whichever is greater
L/min
Peak Flow
Peak Inspiratory Flow in Liters
per Minute
3 to 150 L/min (Adult)
1 to 75 L/min (Pediatric)
0.4 to 30.0 L/min (Neonate)
± 10% of setting or ± (0.2 L/min + 10% of
setting), whichever is greater
sec
Insp Time
Inspiratory Time in Seconds
0.20 to 5.00 sec
(Adult/Pediatric)
0.15 to 3.00 sec (Neonate)
± 0.10 sec
sec
Insp Pause
Sets an inspiratory pause which
will be in effect for each Volume
breath delivered
0.0 to 3.0 sec
± 0.10 sec
cmH2O
PSV
Pressure Support in centimeters
of water pressure
0 to 90 cmH2O (Adult/Pediatric)
0 to 80 cmH2O (Neonate)
± 3 cmH2O or ± 10% whichever is greater
cmH2O
PEEP
Positive end expiratory pressure
in centimeters of water pressure
0 to 50 cmH2O
± 2 cmH2O or ± 5% of setting, whichever is
greater
Sets inspiratory flow trigger
point in liters per minute
0.1 to 20.0 L/min
+ 1.0 / − 2.0 L/min ( for PEEP < 30 cmH2O)
bpm
Rate
ml
Volume
L/min
Flow Trig
+ 2.0 / − 3.0 L/min ( for PEEP > 30 cmH2O)
± (0.2 L/min + 10% of setting) (Wye flow
sensor only)
Controls the percentage of
oxygen in the delivered gas.
21% to 100%
± 3% O2
cmH2O
Pres High
In APRV / BIPHASIC mode,
controls the baseline pressure
achieved during Time High.
0 to 90 cm H2O
± 3 cmH2O
sec
Time High
In APRV / BIPHASIC mode sets
the minimum time for which the
high-pressure setting is
maintained.
0.20 to 30.0 sec
± 0.1 sec
sec
Time Low
In APRV / BIPHASIC mode sets
the minimum time for which the
low pressure setting is
maintained.
0.20 to 30.0 sec
± 0.1 sec
cmH2O
Pres Low
In APRV / BIPHASIC mode
controls the baseline pressure
achieved during Time Low.
0 to 45 cmH2O
± 2 cmH2O or ± 5% of setting, whichever is
greater
%
%O2
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To Activate a Primary Control:
To activate a primary breath control, press the touch screen directly over the
control. The control highlights (changes color) indicating that it is active.
Figure 3.24 Highlighted Control
To modify the settings for the highlighted control, turn the data dial
below the touch screen (see figure 3.25). Turning in a clockwise
direction increases the selected value, turning counterclockwise
decreases it.
Figure 3.25 Data dial.
To accept the displayed value, either press the touch screen directly over the highlighted control or press the ACCEPT
membrane button to the left of the data dial. The control color will change back to normal and the ventilator will begin
operating with the new setting. If you press the CANCEL button or do not actively accept the new setting within 15
seconds, ventilation will continue at the previous settings.
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Descriptions of Primary Breath Controls
Breath Rate (Rate)
The breath rate control sets the breath interval. Its function is dependent upon the selected mode of ventilation and it has
different effects on the breath cycle, depending on which mode is selected.
Range:
1 to 150 bpm (Neonate / Pediatric)
1 to 120 bpm (Adult)
Breath Interval: (60/Rate) sec.
Defaults:
12 bpm
(Adult)
12 bpm
(Pediatric)
20 bpm
(Neonate)
Tidal Volume (Volume)
A volume breath delivers a predetermined volume of gas to the patient. Tidal Volume, together with the Insp Flow, and
Waveform settings determine how the volume breath is delivered.
Range:
0.10 to 2.50 L
(Adult)
25 to 500 ml
(Pediatric)
2.0 to 300 ml
(Neonate)
Defaults:
0.50 L
(Adult)
100 ml
(Pediatric)
2.0 ml
(Neonate)
Sigh:
1.5 x Volume
(Adult/Pediatric only)
Note
When operated from the internal compressor, the maximum Tidal Volume that the ventilator can achieve is 2.0 L.
The maximum minute volume that the ventilator is capable of delivering using wall gas supply is at least 60L and using
internal compressor is 40L.
Inspiratory Pressure (Insp Pres)
During a mandatory pressure breath, the ventilator controls the inspiratory pressure in the circuit. For Pressure & TCPL
breaths, the pressure achieved is a combination of the preset Insp. Pres. level plus PEEP.
Range:
0 to 90 cmH2O (Adult/Pediatric)
0 to 80 cmH2O (Neonate)
Maximum Flow: > 200 L/min
(Adult)
< 120 L/min
(Pediatric)
< 50 L/min
(Neonate)
Default:
15 cmH2O
Note
The ventilator will not allow the operator to set a Peak Inspiratory Pressure (Insp Pres or PSV + PEEP, or baseline
pressure in APRV / BiPhasic, greater than 90 cmH2O). The ventilator will deliver an on screen Pop-Up Message stating
that the Ppeak > 90 cmH2O. The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak
to less than or equal to 90 cmH2O.
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Peak Flow
Peak flow is the flow delivered by the ventilator during the inspiratory phase of a mandatory volume or TCPL breath.
Range:
Defaults:
3 to 150 L/min
(Adult)
1 to 75 L/min
(Pediatric)
0.4 to 30.0 L/min
(Neonate)
60 L/min
(Adult)
20 L/min
(Pediatric)
8.0 L/min
(Neonate)
Inspiratory Time (I-Time)
The I-Time control sets the inspiratory time cycle variable for all mandatory pressure, TCPL or PRVC breaths.
Range:
0.20 to 5.00 seconds
0.15 to 3.00 seconds
(Adult/Pediatric)
(Neonate)
Default:
1.0 second
0.75 seconds
0.35 second
(Adult)
(Pediatric)
(Neonate)
Note
If the preset I-Time is greater than actual I- Time (as determined by Vt, FP, and the waveform), an Inspiratory Pause time
equal to the preset I-Time minus the actual I- Time is added to the breath.
Inspiratory Pause (Insp Pause)
Sets an Inspiratory Pause, which will be in effect for each volume breath delivered.
A preset inspiratory pause will be delivered with each volume breath.
Range:
Default:
0.00 to 3.00 seconds
0.00 second
PSV (Pressure Support)
The PSV control sets the pressure in the circuit during a pressure supported breath.
Range:
0 to 90 cmH2O
(Adult/Pediatric)
0 to 80 cmH2O
(Neonate)
Maximum Flow: > 200 L/min
(Adult)
< 120 L/min
(Pediatric)
< 50 L/min
(Neonate)
Default:
0 cmH2O
Note
The ventilator will not allow the operator to set a Peak Inspiratory Pressure (Insp Pres or PSV + PEEP, or baseline
pressure in APRV / BiPhasic, greater than 90 cmH2O). The ventilator will deliver an on screen Pop-Up Message stating
that the Ppeak > 90 cmH2O. The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak
to less than or equal to 90 cmH2O.
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Note
In adult and pediatric ventilation, a minimum of 2 cmH2O of PSV above PEEP is applied even when the control is set to
zero.
Note
IF PSV level is insufficient to meet patient demand, premature termination of the breath may occur with auto-cycling. In
these cases the PSV level should be increased slightly.
Figure 3.26 PSV Waveform
In figure 3.26 breath number 1 represents the flow tracing which occurs when the PSV level is insufficient to meet the
patient demand. Breath two shows resolution after increasing the PSV level slightly. (Pressure tracing will show a similar
appearance).
Note
Monitored airway pressures (inspiratory) will be higher than set when AAC is active. With an inspiratory pressure setting
of zero, AAC will still provide an elevated airway pressure, to compensate for the resistance of the endotracheal tube.
Positive End Expiratory Pressure (PEEP)
PEEP is the pressure that is maintained in the patient circuit at the end of exhalation.
Range:
0 to 50 cmH2O
Defaults:
6 cmH2O
3 cmH2O
(Adult/Pediatric)
(Neonate)
Note
The ventilator will not allow the operator to set a Peak Inspiratory Pressure (Insp Pres or PSV + PEEP, or baseline
pressure in APRV / BiPhasic, greater than 90 cmH2O). The ventilator will deliver an on screen Pop-Up Message stating
that the Ppeak > 90 cmH2O. The operator must change the Inspiratory Pressure and or PEEP setting to limit the Ppeak
to less than or equal to 90 cmH2O.
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Inspiratory Flow Trigger (Flow Trig)
The inspiratory trigger mechanism* is activated when the Net Flow becomes greater than the Inspiratory Flow Trigger
setting. Net Flow is defined as [Delivered Flow − Exhaled Flow] (or Wye Inspiratory Flow when using a wye flow
sensor). When the Inspiratory Flow Trigger is enabled, a low level of Bias Flow is delivered to the patient circuit during
the exhalation phase of the breath.
Range:
0.1 to 20.0 L/min
Defaults:
1.0 L/min
0.5 L/min
(Adult/Pediatric)
(Neonate)
*See Also Pressure Trigger in Advanced Settings, this chapter.
Note
To ensure adequate bias flow for inspiratory triggering the bias flow setting should be at least 0.5 liters per minute
greater than the flow trigger threshold.
%O2
The % O2 control sets the percentage of oxygen in the delivered gas.
Range:
21 to 100%
Default:
40%
Note
During Heliox administration the %O2 control sets the percent of Oxygen in the delivered gas. The balance of the
delivered gas is Helium.
Pressure High (Pres High)
This control is only available in APRV / BIPHASIC Mode. It controls the baseline pressure achieved during Time High.
Range: 0 to 90 cmH2O
Default: 15 cmH2O
Time High
Available in APRV / BIPHASIC mode only, this control sets the maximum time for which the Pressure High setting is
maintained.
Range: 0.2 to 30 seconds
Default: 4 seconds
Time Low
In APRV / BIPHASIC mode, this control sets the maximum time for which the Pressure Low setting is maintained.
Range: 0.2 to 30 seconds
Default: 2 second
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Pressure Low
In APRV / BIPHASIC Mode, this control sets the baseline pressure achieved during Time Low.
Range: 0 to 45 cmH2O
Default: 6 cmH2O
Advanced Settings
When the mode and the primary breath controls have been set, you can further refine delivery of the breath by accessing
the Advanced Settings.
Accessing the Advanced Settings
To access the advanced settings group, press the ADV
SETTINGS membrane button located to the left of the touch
screen between the Mode and the Set-up buttons. The LED
indicator on the button illuminates and the Advanced Settings
screen appears. When you select a primary control by pressing
and highlighting the control at the bottom of the touch screen,
the available advanced settings for that selected control appear
in the advanced settings screen.
Figure 3.27 The Advanced Settings
membrane button
Primary Controls, which feature an advanced setting, will display a
yellow triangle to the right of the control name.
Figure 3.28 Advanced settings indicator
Note
Not every primary control will have an associated advanced setting.
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Table 3.4 Controls and Advanced Settings Associated with Breath Type & Mode
BREATH
TYPE
& MODE
VOL A/C
VOL SIMV
PRES
A/C
PRES
SIMV
PRVC A/C
PRVC
SIMV
RATE
bpm
*
*
*
*
*
VOLUME
ml
*
*
*
CPAP/PSV
APRV /
BIPHASIC
*
* Apnea
* Apnea
*
* Apnea
* Apnea
* Apnea
TCPL A/C
TCPL
SIMV
*
*
* Apnea
*
*
* Apnea
* Apnea
*
*
* Apnea
* Apnea
*
*
* Apnea
* Apnea
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
PRIMARY
CONTROLS
INSP PRES
cmH2O
PEAK FLOW
L/min
*
*
PSV
cmH2O
PEEP
cmH2O
FLOW TRIG
L/min
% OXYGEN
%o2
PRES HIGH
cmH2O
TIME HIGH
sec
TIME LOW
sec
PRES LOW
cmH2O
Mode
*
*
*
*
*
*
*
*
*
*
*
*
*
Mode
Mode
*
*
*
*
*
*
*
Vsync*,
Vsync*,
Mach
Mach vol,
Vsync
Vsync rise*,
vol,
Vol limit,
rise*,
Sigh,**
Vol limit,
Insp rise,
Sigh,**
Waveform,
Insp rise,
Flow
Waveform,
Vol. Limit,
Flow
cycle,
Bias flow,
PSV rise,
cycle,
PSV rise,
Pres trig
PSV cycle,
Bias
PSV cycle,
PSV Tmax,
flow,
PSV
Vol limit
Bias flow,
Pres trig
Tmax,
(when
Pres trig,
Bias flow,
Vsync =
Flow
Pres trig
ON), Flow
Cycle*,
Cycle*,
Demand
Demand
Flow
Flow
* Available only with Vsync activated for adult or pediatric patients only.
** Available for adult and pediatric patients only.
ADVANCED
SETTINGS
AVAILABLE
WITHIN EACH
MODE
Mode
Mode
*
INSP TIME
sec
INSP PAUSE
sec
*
Mode
*
*
*
*
*
*
*
Mode
Mode
Mode
Mode
Mode
Mode
*
Insp rise,
Bias flow,
Pres trig
Vol Limit,
Flow
Cycle
Vol limit,
PSV rise,
PSV cycle,
PSV
Tmax,
Bias flow,
Pres trig,
Flow
Cycle
Vol limit,
PSV rise,
PSV cycle,
PSV Tmax,
Bias flow,
Pres trig
Vol limit,
PSV rise,
PSV cycle,
PSV
Tmax,
Bias flow,
Pres trig
T High
Sync
T High
PSV
T Low
Sync
Vol limit,
Flow
cycle,
Bias flow,
Pres trig
Vol limit,
Flow
cycle,
PSV rise,
PSV
cycle,
PSV
Tmax,
Bias flow,
Pres trig
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Advanced Settings Characteristics and Ranges
Volume Limit (Vol Limit)
The Vol Limit setting sets the volume limit for a Pressure Limited breath. When the volume delivered to the patient
meets or exceeds the preset Vol Limit, the inspiratory phase of the breath is terminated.
Range:
Normal:
0.10 to 2.50 L
25 to 750 ml
2.0 to 300.0 ml
(Adult)
(Pediatric)
(Neonate)
Defaults:
2.50 L
500 ml
300 ml
(Adult)
(Pediatric)
(Neonate)
The Vol Limit setting sets the volume limit for a Pressure limited breath. When the volume delivered to the patient meets
or exceeds the preset Vol Limit, the inspiratory phase of the breath is terminated.
Volume Limit is active for Pressure, PRVC / Vsync, TCPL, and PSV breaths only. In neonatal applications Volume Limit
requires the use of a wye flow sensor. Whenever a proximal flow sensor is used (Neonatal, Pediatric or Adult
applications) the Volume Limit is activated by the inspiratory tidal volume measured by the wye flow sensor. In adult and
pediatric applications where no wye flow sensor is used Volume Limit is determined by the calculated inspiratory wye
flow. When the volume limit threshold has been reached the ventilator alarm status indicator will change to yellow and
display the words Volume Limit. The alarm status indicator cannot be reset until the ventilator has delivered a breath,
which does not meet the volume limit threshold. To reset the alarm status window use the alarm-reset button.
Note
Excessive inspiratory flow rates or highly compliant ventilator circuits may allow delivery of a tidal volume that exceeds
the volume limit setting. This is due to the ventilator circuit recoiling and providing additional tidal volume to the patient.
Delivered tidal volumes should be closely monitored to ensure Volume Limit accuracy.
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Machine Volume (Mach Vol)
The Machine Volume control sets the minimum tidal volume delivered from the ventilator when the control is activated
in a pressure control breath. This control is always used with the time cycling criterion in pressure control ventilation.
Machine volume is circuit compliance compensated in adult and pediatric applications.
Range:
Normal:
0.10 to 2.50 L
25 to 500 ml
2.0 to 300.0 ml
(Adult)
(Pediatric)
(Neonate)
Defaults:
0L
0 ml
0 ml
(Adult)
(Pediatric)
(Neonate)
Once you set the machine volume, the ventilator calculates the decelerating inspiratory flow required to deliver the
Machine Volume in the set inspiratory time. When a Pressure Control breath is delivered and Peak Flow decelerates to
this calculated peak inspiratory flow, if the Machine Volume has not been met the ventilator will automatically transition to
a continuous flow until the Machine Volume has been delivered. Once the set Machine Volume has been delivered the
ventilator will cycle into exhalation. When the Machine Volume is met or exceeded during delivery of the pressure
control breath, the ventilator will complete the breath as a normal Pressure Control breath.
During this transition in flow, the Inspiratory Time will remain constant and the Peak Inspiratory Pressure will increase to
reach the set Machine Volume. The maximum Peak Inspiratory Pressure is determined by the High Peak Pressure
alarm setting.
Note
Pmax is disabled when Machine Volume is set. In the event Flow Cycling is active in Pressure Control the ventilator will
not Flow Cycle until the Machine Volume has been met. Machine Volume must be set to zero to change patient size.
To set Machine Volume in adult and pediatric applications (with circuit compliance compensation active) simply set the
minimum desired tidal volume.
In neonatal applications with proximal flow sensor in use:
•
Adjust the peak inspiratory pressure to reach the desired tidal volume.
•
Select Vdel as one of the monitored parameters. Read the Vdel (uncorrected Tidal Volume delivered from the
machine) during a pressure control breath.
•
Set the Machine volume to or slightly below the Vdel measurement. This will set the machine volume to a level
that will provide more consistent tidal volume delivery in the case of slight decreases in lung compliance.
Note
To protect against larger changes in lung compliance, the machine volume should be set higher and Volume Limit
should be added.
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Insp Rise
The Inspiratory Rise setting controls the slope of the pressure rise during a mandatory breath. This control is a relative
control with fast being a setting of 1 and slow, a setting of 9.
Range:
1 to 9
Default:
5
The Inspiratory Rise control is not active for TCPL breaths.
Flow Cycle
The flow cycle setting sets the percentage of the peak inspiratory flow (Peak Flow), at which the inspiratory phase of a
Pressure Control, TCPL or PRVC/Vsync breath is terminated.
Range:
0 (Off) to 45%
Default:
0% (Off)
Flow cycling is active for Pressure, PRVC/Vsync or TCPL breaths only.
Note
If flow cycling is active during a PRVC or Vsync breath flow cycling of the breath can only occur if the target tidal volume
has been delivered. This allows for expiratory synchrony while assuring delivered tidal volume.
Note
If Flow Cycling is active during a pressure control breath, monitored airway pressures (inspiratory) will be higher than set
when AAC is active. In pediatric and adult ventilation with an inspiratory pressure setting of zero AAC will still provide an
elevated airway pressure, which will compensate for the resistance of the endotracheal tube.
Waveform
During the delivery of a volume breath, flow can be delivered in one of two user selectable waveforms: square wave or
decelerating wave. The default waveform is Decelerating Wave.
Square Wave (Sq)
With this waveform selected, the ventilator delivers gas at the set peak flow for the duration of the inspiration.
Decelerating Wave (Dec)
With this waveform selected, the ventilator delivers gas starting at the peak flow and decreasing until the flow
reaches 50% of the set peak flow.
Demand Flow
Enables and disables the Intra-Breath Demand system in volume controlled ventilation. The default position is on.
Note
Should the patient’s inspiratory demand be sustained beyond the controlled inspiratory time plus the minimum expiratory
time with the demand system turned off auto-cycling or double cycling may occur. This is the result of the patient
demanding more flow than available resulting in a breath trigger after the minimum expiratory time. This may be
resolved by increasing the inspiratory flow rate to meet the patients demand or turning the demand system back on.
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Sigh
The ventilator delivers sigh volume breaths when this setting is ON. A sigh volume breath is delivered every 100th breath
in place of the next normal volume breath.
Range:
Off, On (every 100 breaths)
Sigh Volume:
1.5 times set tidal volume
Sigh Breath Interval (sec):
Set Normal Breath Interval x 2 (Assist mode) or
set Normal Breath Interval (SIMV mode)
Default:
Off
Sigh breaths are only available for Volume breaths in Assist and SIMV modes for adult and pediatric patients.
Bias Flow
The Bias Flow control sets the background flow available between breaths. Additionally, this control establishes the base
flow that is used for flow triggering.
Range:
Defaults:
0.4 to 5.0 L/min
2.0 L/min
Note
To ensure adequate bias flow for inspiratory triggering the bias flow setting should be at least 0.5 liters per minute
greater than the flow trigger threshold. Consult the ventilator circuit manufacturer to ensure that bias flow setting is
sufficient to prevent overheating of the ventilator circuit.
Pres Trig
Sets the level below PEEP at which the inspiratory trigger mechanism is activated. When the pressure in the patient
circuit falls below PEEP by the set pressure trigger level, the ventilator will cycle to inspiration.
Range:
Default:
0.1 to 20.0 cmH2O
3.0 cmH2O
Vsync
Vsync breaths are:
•
Controlled by pressure (inspiratory + PEEP) and volume;
•
Limited by pressure (inspiratory + PEEP + margin);
•
Cycled by time. Inspiratory time in Vsync is determined indirectly by setting the peak inspiratory flow. The set
inspiratory time is displayed in the message bar.
Vsync breath operation is as follows:
When Vsync is selected, a decelerating flow, volume test breath to the set tidal volume with a 40 msec pause is
delivered to the patient. The ventilator sets the target pressure at the end inspiratory pressure of the test breath or the
first pressure control breath. The next breath and all subsequent breaths are delivered as pressure control breaths.
Inspiratory pressure is adjusted automatically, based on the dynamic compliance of the previous breath, to maintain the
target volume. The maximum step change between two consecutive breaths is 3 centimeters of water pressure. The
maximum tidal volume delivered in a single breath is determined by the Volume Limit setting.
This test breath sequence is initiated when any of the following occur:
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•
•
•
•
•
•
•
3-43
Entering the Mode (Vsync)
Changing the set tidal volume while in Vsync
Reaching the Volume Limit setting
Delivered tidal volume > 1.5 times the set volume
Flow termination of the test breath
Exiting Standby
Activation of any of the following alarms
-
High Peak Pressure Alarm
Low Peak Alarm
Low PEEP Alarm
Patient Circuit Disconnect Alarm
I-Time Limit
I:E Limit
Vsync is only available for adult and pediatric patients.
Note
If flow cycling is active during a PRVC or Vsync breath flow cycling of the breath can only occur if the target tidal volume
has been delivered. This allows for expiratory synchrony while assuring delivered tidal volume.
Note
The Peak Flow control sets the flow rate, which is used by the ventilator for the test breath only. The ventilator uses the
Peak Flow setting and Inspiratory Pause to determine the maximum inspiratory time during Vsync ventilation.
Vsync Rise
With Vsync active, this control sets the slope of the pressure rise during the volume breath. It is a relative control ranging
from fast (1) to slow (9).
Range:
1 to 9
Default:
5
PSV Rise
This control sets the slope of the pressure rise during a pressure-supported breath. It is a relative control with a range
from fast (1) to slow (9).
Range:
1 to 9
Default:
5
PSV Cycle
Sets the percentage of peak inspiratory flow at which the inspiratory phase of a PSV breath is terminated.
Range:
5 to 45%
Default:
25% (Adult/Pediatric)
10% (Neonate)
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PSV Tmax
Controls the maximum inspiratory time of a pressure-supported breath.
Range:
0.20 to 5.00 seconds (Adult/Pediatric)
0.15 to 3.00 (Neonate)
Default:
5.00 seconds (Adult)
0.75 seconds (Pediatric)
0.35 seconds (Neonate)
Note
PSV Rise, PSV Cycle and PSV Tmax are active even if the PSV level is set to Zero
Independent Lung Ventilation (ILV)
Independent lung ventilation allows 2 ventilators to be synchronized to the same breath rate (the rate control set on the
master ventilator), while all other primary and advanced controls for each ventilator can be set independently. Master
and slave ventilators need not operate in the same mode during ILV.
The AVEA offers a port to allow Independent Lung Ventilation (ILV). This connection is located on the rear panel (see
figure 2.19, C). The output provides a 5 VDC logic signal, synchronized to the breath phase of the master ventilator.
A specially configured accessory cable kit, available from VIASYS (P/N 16246) is required to implement ILV.
WARNING
Do NOT attempt to connect a standard DB-25 cable to this receptacle. This could cause damage to the
ventilator. A specially configured cable is required for ALL features associated with this connector. Contact
VIASYS Tech Support.
To enable Independent Lung Ventilation, refer to Chapter 2, Ventilator Setup, Independent Lung Ventilation (ILV).
NOTE
During ILV, the alarm limits for each ventilator should be set to appropriate levels for each ventilator to assure
appropriate patient protection. Confirm apnea timer settings and apnea ventilation settings for the Slave ventilator. These
settings will be used in the event of a loss of signal from the Master ventilator.
WARNING
Since the master ventilator controls the breath rate for both ventilators, care should be taken when setting the other
independent breath controls for the slave ventilator, to ensure sufficient time is allowed for exhalation to occur.
CAUTION
If the cable connecting the master and slave ventilators becomes detached, the slave ventilator will alarm for loss of
signal. In this event, only the master ventilator will continue to provide ventilation at the current settings. The slave
ventilator will begin apnea ventilation after its apnea timer has elapsed at its current apnea ventilation settings.
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Graphic Displays
Graphics Colors
Graphic displays on AVEA may appear as red, blue, yellow, green or purple tracings. These colors may provide useful
information to the operator about breath delivery and are consistent between both waveform and loop graphic
displays.
A RED tracing indicates the inspiratory portion of a mandatory breath. A YELLOW tracing indicates the inspiratory
portion of an assisted or spontaneous breath (patient assisted or spontaneous breaths are also denoted with a yellow
demand indicator that appears in the left hand corner of the mode indicator). BLUE tracings represent the expiratory
phase of a mandatory, assisted or spontaneous breath. A GREEN tracing during the expiratory phase of a single breath
indicates that a purge of the expiratory flow sensor or the wye flow sensor (if attached) has occurred. A PURPLE tracing
indicates safety state, which occurs when the safety valve is open.
Waveforms
Three waveforms can be selected and simultaneously displayed on the MAIN screen as shown in figure 4.1.
Note
Waveforms are circuit compliance compensated.
Waveform
Heading
Display
Figure 4.1 Waveform Graphs Displayed on the Main Screen
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When you press and highlight the waveform heading display on the touch screen a scrollable menu appears showing the
choice of waveforms (see figure 4.2).
Waveform
Selection Menu
Highlighted
Waveform
Heading
Y-axis of
graph
X axis of
graph
Figure 4.2 Waveform Selection
To scroll through the waveform choices, turn the data dial under the touch screen. To
make your selection, touch the touch screen menu again or press the Accept
membrane button shown here next to the data dial.
Figure 4.3 Data dial
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Each waveform is continuously updated unless the PRINT or FREEZE membrane button is pressed.
The PRINT button transfers data to a connected parallel printer.
The FREEZE button freezes the current screen and suspends the screen update until pressed a second time.
Table 4.1 Waveform Choices
Heading Display
Waveform Shown
Paw (cm H2O)
Airway Pressure
Pinsp (cmH20)
Airway Pressure at Machine Outlet
Pes (cmH2O)
Esophageal Pressure
Ptr (cmH2O)
Tracheal Pressure
Ptp (cmH20)
Transpulmonary Pressure
Flow(L/min)
Flow
Vt (ml)
Airway Tidal Volume
Fexp
Finsp
Expiratory flow
Analog 0
Based on analog input scale
Analog 1
Based on analog input scale
Inspiratory Flow
Axis Ranges
The scale (vertical axis) and sweep speed (horizontal axis) of the displayed graphs are also modifiable using the touch
screen. To change the displayed range, press either axis of the displayed graph to highlight it. The highlighted axis can
then be modified using the data dial below the touch screen (see figure 4.3). To accept the change, touch the
highlighted axis again or press Accept.
Time Ranges
0
0
0
0
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12 seconds
30 seconds
60 seconds
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Chapter 4 Monitors, Displays and Maneuvers
AVEA Ventilator Systems
Loops
Accessing the Loops Screen
To access the loops screen press the screens
membrane button to the left of the touch screen on
the UIM. The button is labeled with the icon shown
here.
Select LOOP from the options that appear.
Figure 4.4 Screen Selection
Choice of Loops
The ventilator displays 2 loops in real time, selected from the following.
•
Vt-Flow
Flow / Volume Loop. Inspiratory flow / Volume. If proximal flow sensor is used values are
based on proximal flow sensor measurements.
Available for all patients.
•
PAW - Vt
Airway Pressure / Volume loop. Active for all patients.
•
PES - Vt
Esophageal Pressure vs. Volume loop. This requires the use of an optional esophageal
catheter and is active for adult and pediatric patients only.
•
PTR - Vt
Tracheal Pressure vs. Volume loop. This requires the use of an optional tracheal catheter
and is active for adult and pediatric patients only.
•
PINSP – Vt
Inspiratory Pressure vs. Volume loop.
•
PTp – Vt
Transpulmonary vs. Volume. This requires the use of an optional esophageal catheter and is
active for adult and pediatric patients only.
Note
Loops are circuit compliance compensated
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Chapter 4 Monitors, Displays and Maneuvers
Using the Freeze Button to Compare Loops
You can freeze the Loops screen and select a reference loop for
comparison. When real-time data refreshing resumes (by
pressing the Freeze button again), the selected loop will remain
in the background behind the real time graphic.
To create a reference loop refer to figure 4.6, 4.7 and 4.8 and do
the following.
Figure 4.5 Frozen Flow / Volume Loop
Saving a loop
Press the Freeze button to freeze the loop you wish to use as a
reference then press the Save Loop touch screen display in the
right hand bar, beneath the frozen graphic display. See figure 4.6.
Figure 4.6 Reference Loop ON/OFF button (OFF)
This puts the selected loop into memory and places a time
reference into a field in the left hand bar beneath the graphics
display as shown in figure 4.7. A total of four (4) loops can be
saved at one time. When the fifth loop is saved, the oldest loop
is removed.
Figure 4.7 Saved Loops Display
Creating a reference loop
Press the touch screen directly over the touch screen field
in the left bar which represents the saved loop you wish to use
as a reference. The field will highlight (see figure 4.7). Press
the “Ref Loop ON/OFF” field on the right hand bar (see figures
4.6 and 4.8) to turn the reference loop on.
When you press the Freeze button again, the reference loop remains
visible in the background, while the active display places current
loops in real time over the top of it.
Figure 4.8 Reference Loop ON/OFF
button (ON)
To turn off the reference loop, freeze the screen again and press the “Ref Loop On/Off” toggle button shown in figure
4.8.
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Maneuvers
The AVEA is capable of performing various respiratory mechanics maneuvers. These maneuvers can be accessed from the
screens menu and selecting the Maneuvers screen. Depending on the model, the following maneuvers may be available:
Esophageal, MIP / P100, Inflection Point (Pflex), and AutoPEEPAW. Each maneuver screen includes all controls, monitors, and
waveform or loop graphics pertinent to the selected maneuver.
Note
Maneuvers are not available for Neonate patients. Some alarms may be disabled during a maneuver.
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Esophageal Maneuver Screen
Controls
Selecting Balloon Size and Type
Upon connection of the Balloon Extension Tubing the ventilator will display the Esophageal Balloon Size and
Type dialogue box. You must select the size and type of balloon you intend to use before you will be able to
conduct the Balloon Test.
Note
Disconnecting the Balloon Extension Tubing will require you to select balloon size and type and repeat the
balloon test procedure.
In order to change balloon size or type you must disconnect and re-connect the balloon extension tubing to
open the Esophageal Balloon Size and Type dialogue box.
Selecting a balloon size and type other than the one to be used can result in failure of the balloon test.
Balloon Leak / Size Test
The Balloon Test verifies the integrity and size of the balloon catheter. The ventilator will display a Pass or Fail
message in the message bar at the bottom of the screen.
If the Balloon Test is not passed all connections should be checked to assure they are secure and balloon
integrity should be evaluated.
Note
The Balloon Test must be performed without the balloon in the patient
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Balloon Fill Start / Stop
When the Start key is actuated, the ventilator delivers the volume specified below into the
catheter before esophageal pressure measurement commences.
Adult Catheter:
0.5 to 2.5 mL
Pediatric Catheter:
0.5 to 1.25 mL
The ventilator will evacuate and refill the balloon every 30 minutes to maintain measurement
accuracy.
When the Stop key is actuated, the ventilator evacuates the balloon prior to removal of the
catheter from the patient.
Note
Do Not inflate the balloon until after it has been placed in the patient. The balloon should be evacuated prior to
removal from patient.
Chest wall Compliance (CCW)
The preset Chest wall Compliance (CCW) is used by the ventilator to calculate work of
breathing.
Range:
0 to 300 mL/cmH2O
Resolution:
1 mL/cmH2O
Default:
200 mL/cmH2O
Alarms
All currently available alarms are active during the Esophageal maneuver.
To Perform Esophageal Maneuvers
Esophageal measurements require the use of an esophageal balloon, which can be purchased from VIASYS
Respiratory Care Inc.
From the Maneuvers Screen menu select Esophageal
Before placing the balloon in the patient a balloon test should be performed. Connect the esophageal balloon
extension tubing to the EPM panel on the AVEA as described in Chapter 2. Remove the new esophageal balloon from
its package and connect it to the pinned connector on the patient end of the extension tubing.
Allow the balloon to hang freely and not contact any surfaces and press the Balloon Test soft key on the maneuver
screen. The ventilator will perform a leak test by evacuating the balloon, filling it to the proper specification, measuring
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the balloon pressure and finally evacuating the balloon. A message will appear on the message bar after the test stating
Pass or Fail.
In the event that the balloon does not pass the leak test, inspect the balloon for damage and replace if necessary. If no
damage is present on the balloon check all connectors on the balloon and extension tubing and repeat the test.
Note
Disconnecting the balloon after passing a balloon test will require that the test be repeated.
Once the balloon has passed the leak test it is ready for placement in the patient. Proper placement of the balloon is
imperative for accurate measurements. During insertion the waveform produced can provide information to confirm
proper placement. An approximate level of placement can be made by measuring the distance from the tip of the nose
to the bottom of the earlobe and then from the earlobe to the distal tip of the xiphoid process.
1. The esophageal pressure waveform correlates to the airway pressure in that they become positive during a
positive pressure breath and negative during a spontaneous breath.
2. The esophageal tracing may show small cardiac oscillations reflective of cardiac activity.
3. Once placed using the above criteria appropriate balloon location can be confirmed by performing an
occlusion technique. This requires that the airway be occluded and the esophageal and airway pressures
compared for similarity.
After the balloon has been inserted and turned on, the ventilator will fill the balloon to the appropriate level and begin
monitoring data. The ventilator will automatically evacuate and refill the balloon every thirty minutes to ensure accuracy
of monitored values.
WARNING
Esophageal balloon placement should only be conducted in patients under the direction of a physician who has
assessed the patients for contraindications to the use of esophageal balloons.
WARNING
Incorrect placement of an esophageal balloon can affect the accuracy of monitored values.
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MIP / P100 Maneuver Screen
The MIP (Maximum Inspiratory Pressure) / P100 maneuver measures the negative deflection in the pressure tracing
during the patient’s active effort to demand a breath. During the maneuver, the inspiratory flow valve remains
closed and no inspiratory flow is delivered. The MIP is an indication of the maximum negative pressure that the
patient can draw, while P100 is an indication of the pressure drop that occurs during the first 100 milliseconds of the
breath.
Controls
Duration
The preset Duration shall determine the maximum amount of time that the maneuver will last.
Normal ventilation will be suspended for the duration of the maneuver and will resume after
the duration has timed out.
Range:
5.0 to 30.0 seconds
Default:
10 seconds
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Sensitivity
The maneuver sensitivity establishes the level below PEEP that the airway pressure must
drop, which determines the onset of a patient effort. This allows the clinician to set the
maneuver appropriate to patient ability.
Range:
0.1 to 5.0 cmH2O
Resolution:
0.1 cmH2O
Default:
3.0 cmH2O
Note
Excessively high setting of the maneuver sensitivity can affect the accuracy of timing for P100 determination.
Start / Stop
The maneuver begins when the START key is actuated. The maneuver will be immediately
terminated should the operator activate the STOP key and normal ventilation will resume.
Note
If the Start key is activated during a mandatory inspiratory breath the maneuver will not commence until the ventilator
cycles into exhalation and the minimum expiratory time of 150 msec has elapsed.
Alarms
All currently available alarms shall be active during the MIP / P100 maneuver except Apnea Interval and
Low PEEP.
To Perform a MIP / P100 Maneuver:
The MIP / P100 maneuver allows the measurement of the Maximum Inspiratory Pressure (MIP) achieved by the patient
during an expiratory hold maneuver. The ventilator can also measure the P100 value which is the maximum inspiratory
pressure achieved in the first 100 milliseconds of the maneuver.
From the Maneuvers Screen select MIP P100
The MIP maneuver screen allows the operator to set:
Duration – This is the time period that ventilation is suspended to conduct the maneuver. Once the Start button is
depressed normal ventilation will be suspended until the Duration time period has elapsed or the operator presses the
Stop button.
Sensitivity – This sets the sensitivity threshold that the ventilator uses to begin the timer for the P100 maneuver. The
default position is three centimeters but can be adjusted by the operator to assure accuracy in patients with minimal
inspiratory effort.
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Note: The maneuver sensitivity setting is used for the maneuver only and does not affect trigger sensitivity.
Start / Stop – Starts and Stops the maneuver.
WARNING
Normal ventilation is suspended for the duration of the maneuver. The patient should be evaluated for
contraindications prior to executing the maneuver. The patient should be directly monitored by trained medical
personnel during the maneuver.
To execute a MIP / P100 maneuver set the Duration and Sensitivity controls to the desired level. Press the Start soft key
on the maneuver screen. The ventilator will close the inspiratory and expiratory valves and begin monitoring. At the
completion of the maneuver the ventilator will display the MIP and P100 values in their respective windows on the
maneuver screen. The MIP and P100 will also be available as trended data on the Trends screen. The maneuver can
be aborted at anytime by pressing the Stop soft key.
Inflection Point (Pflex) Maneuver Screen
The Inflection point (Pflex) maneuver is performed on patients during mandatory ventilation. The upper and lower
inflection points are automatically indicated on the inspiratory portion of a Pressure/Volume (PAW / Vol) Loop.
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Note
Normal ventilation shall be suspended for the duration of the maneuver. The maneuver will be aborted if a patient effort
is detected and the message bar will indicate a message stating that patient effort was detected.
Controls
Tidal Volume (Volume)
This is the volume of gas delivered to the patient during the maneuver.
Range:
0.10 to 2.50 L (Adult)
25 to 500 mL (Pediatric)
Resolution:
0.01 L
1 mL
(Adult)
(Pediatric)
Default:
0.25 L
25 mL
(Adult)
(Pediatric)
Peak Flow
Sets the Peak Flow used for the maneuver.
Note: A square wave flow pattern is used for the maneuver.
Range:
0.5 to 5.0 LPM
Resolution:
0.1 LPM
Default:
1.0 LPM
Maneuver PEEP (PEEP)
The Maneuver PEEP determines the baseline pressure at which the maneuver begins.
Note: The Maneuver PEEP can be set independent of the PEEP used during normal
ventilation.
Range:
0 to 50 cmH2O
Resolution:
1 cmH2O
Default:
0 cmH2O
PEEP Equilibration Time (PEEP Teq)
The PEEP Equilibration Time determines the amount of time allowed for equilibration of the
airway pressure before slow flow commences. Upon activation of the maneuver the ventilator
will set PEEP to the Maneuver PEEP level for the PEEP Equilibration Time prior to beginning
the slow flow maneuver.
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Range:
0.0 to 30.0 seconds
Resolution:
0.1 second
Default:
1.0 second
AVEA Ventilator Systems
Sensitivity
The preset Sensitivity establishes the level below the peak airway pressure that the pressure
must drop to abort the Pflex maneuver.
Note
The maneuver will be aborted if a patient effort is detected and the message bar will indicate a message stating that
patient effort was detected.
Range:
0.1 to 5.0 cmH2O
Resolution:
0.1 cmH2O
Default:
3.0 cmH2O
Start / Stop
The maneuver shall begin when the START key is actuated. The maneuver shall be
immediately terminated when the STOP key is actuated, a patient effort is detected or the
maneuver tidal volume has been delivered and normal ventilation will resume.
Upper Pflex and Lower Pflex determination
Once the maneuver tidal volume has been delivered the ventilator will cycle into exhalation. At the end
of exhalation, the PAW / Vol loop will freeze automatically, the upper and lower inflection points, as well as
the delta Pflex volume, will be calculated and displayed. The ventilator will return to normal ventilation at
the current ventilator settings.
The user can, should they choose to do so, override the Pflex values by moving the Pflex indicators to a
new point along the PV loop and pressing the appropriate set key. The corresponding Pflex values and
delta Pflex volume change to represent values based on the current position of the indicators. The
ventilator will store up to four PV loops and their respective inflection points simultaneously.
Note
Once the values have been redefined by the operator the original values cannot be restored.
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Alarms
All currently available alarms shall be active during a Pflex maneuver except Apnea Interval and I-Time
Limit.
To Perform a Pflex Maneuver
The Pflex maneuver allows the clinician to determine opening pressures of the lung during a slow flow volume controlled
breath. Because this maneuver is performed at a slow inspiratory flow rate the effects of respiratory system resistance
are minimized.
Note
Requires a passive patient. In the event that a patient effort is detected the ventilator will abort the maneuver and deliver
a patient effort detected message while simultaneously returning to normal ventilation at the current settings.
From the Maneuvers Screen select Pflex
The Pflex maneuver screen allows the operator to set:
Tidal Volume (Vt) – This is the tidal volume delivered to the patient during the maneuver. This setting has no effect on
the settings during normal ventilation and can be set to any tidal volume desired independent of the current mode of
ventilation.
Flow – This setting is adjustable from 0.5 to 5 l/min and controls the inspiratory flow used to deliver the maneuver tidal
volume.
PEEP - The is the PEEP used for the Slow Flow Maneuver. The operator can select any PEEP level independent of the
control PEEP used during controlled ventilation.
PEEPTeq – This control sets the equilibration at the Maneuver PEEP after which the Slow Flow Maneuver begins.
Sensitivity – This sets the sensitivity threshold that the ventilator uses to detect patient effort during the Slow Flow
Maneuver. The default position is three centimeters but can be adjusted by the operator to assure accurate sensitivity in
all applications.
Start / Stop – Starts and Stops the maneuver.
Note
All maneuver control settings are independent of control settings in normal ventilation.
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WARNING
Normal ventilation is suspended for the duration of the maneuver. The patient should be evaluated for
contraindications prior to executing the maneuver. The patient should be directly monitored by trained medical
personnel during the maneuver.
To execute a Pflex maneuver set the Tidal Volume, Flow, Maneuver PEEP, PEEP Equilibration time and Sensitivity.
Press the Start soft key on the maneuver screen. The ventilator will suspend normal ventilation and begin delivering the
Maneuver Tidal Volume at the set Flow. The corresponding Pressure / Volume curve will be drawn by the ventilator as
the volume is delivered to the patient. Once complete the ventilator will automatically resume normal ventilation and
Freeze the graphics display. The maneuver can be aborted at anytime by pressing the Stop soft key. If at anytime
during the maneuver the ventilator detects a patient effort, the ventilator will cycle into exhalation and normal ventilation
will resume.
The measured Pflex, Pflex Lwr, Pflex Upr and Vdelta will be displayed, if they can be determined. At this point the
operator can choose to accept the inflection points as determined by the ventilator or the operator can choose to set the
inflection points manually.
To set the inflection points manually simply scroll the cursor to the desired position with the Data Dial and press the Set
Pflex Lwr or Set Pflex Upr softkey. The Vdelta will be automatically recalculated.
The measured data can be saved by pressing the Save Loop softkey. Up to four loops may be saved, when a fifth loop
is saved the oldest loop and data will be erased.
Note
If the loop and corresponding data are not saved by the operator the data will be erased after exiting the maneuver
screen.
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AutoPEEP Maneuver Screen
AutoPEEP is the airway pressure at the end of exhalation immediately prior to the beginning of the next mandatory
inspiration. During the execution of this maneuver the ventilator will execute an expiratory hold in which both the
inspiratory and expiratory valves will be closed. The ventilator will establish the AutoPEEP measurement when the
system pressure reaches equilibration, at the next mandatory breath interval or 5 seconds whichever is shorter.
Controls
Sensitivity
The preset Sensitivity establishes the level that the airway pressure must drop below PEEP to
abort the AutoPEEP maneuver.
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Range:
0.1 to 5.0 cmH2O
Resolution:
0.1 cmH2O
Default:
3.0 cmH2O
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Start / Stop
The maneuver begins when the START key is actuated and the ventilator is in exhalation.
The maneuver will stop immediately when the STOP key is activated, the maneuver is
completed or a patient effort is detected and normal ventilation will resume.
Note
The maneuver will be aborted if a patient effort is detected and the message bar will indicate a message stating that
patient effort was detected.
Alarms
All currently available alarms shall be active during the AutoPEEP maneuver.
To Perform an AutoPEEP Maneuver
The AutoPEEP maneuver allows the measurement of PEEP generated within the breathing system (patient and circuit)
during an expiratory hold maneuver. This maneuver requires a passive patient.
From the Maneuvers Screen select AutoPEEP
The AutoPEEP maneuver screen allows the operator to set:
Sensitivity – This sets the sensitivity threshold that the ventilator uses to detect patient effort during the AutoPEEP
Maneuver. The default position is three centimeters but can be adjusted by the operator to assure accurate sensitivity in
all applications.
Start / Stop – Starts and Stops the maneuver.
To execute an AutoPEEP maneuver the operator sets the Sensitivity appropriate for the patient and presses the Start
softkey. The ventilator will then close the inspiratory and expiratory valves and allow the pressure to equilibrate between
the patient and the breathing circuit. At the completion of the maneuver the ventilator will display the AutoPEEP and
dAutoPEEP values in their respective windows on the maneuver screen. The AutoPEEP and dAutoPEEP will also be
available as trended data on the Trends screen. The maneuver can be aborted at anytime by pressing the Stop soft key.
Note
The AutoPEEP value will be set at the next mandatory breath interval or 5 seconds whichever is sooner.
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Tracheal Catheter Placement
Some advanced mechanics measurements on the AVEA require the use of a tracheal catheter. To ensure accuracy of
measurements and to minimize risk of adverse events the tracheal catheter should be placed in the endotracheal tube
and not extend beyond the tip.
To assure proper placement, measure the length of the endotracheal tube, and its associated adapters. Insert the
tracheal catheter into the endotracheal tube to a distance not greater than this measurement.
WARNING
Inserting the tracheal catheter beyond the tip of the endotracheal tube may cause irritation and inflammation of
the trachea and airways or produce vagal responses in some patients.
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Digital Displays
The Monitor Screen
To access the monitor screen press the Screens
membrane button to the left of the touch screen on the
UIM. The button is labeled with the icon shown here.
Select MONITOR from the selection box that appears.
Figure 4.4 Screen Selection
The monitor screen can display a total of 15 different monitored values simultaneously. Monitor Displays are updated at
the start of the next inspiration or every 10 seconds, whichever occurs first. Each value can be independently selected
from a the available choices (see table 4.2).
1.
Use the touch screen to select and highlight the monitor you wish to set.
2.
Turn the data dial beneath the touch screen to scroll through the menu choices.
3.
To accept your selection, either touch the highlighted display or press the accept button adjacent to the
data dial (see figure 4.3).
Figure 4.5 The Monitor Screen
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Table 4.2 Monitored Values Menu Choices
For a full description of the specifications and calculation of monitored displays see Appendix D, Monitoring
Specifications.
Note
Depending on the model and options, not all of the following displays may be available.
Display
ml
Vte
ml/kg
Vte/kg
ml
Vti
ml
Vti/kg
ml
Spon Vt
ml/Kg
Spon Vt/Kg
ml
Mand Vt
ml/kg
Mand Vt/Kg
Value
Expired tidal volume
Expired tidal volume adjusted for patient weight
Inspired tidal volume
Inspired tidal volume adjusted for patient weight
Spontaneous tidal volume exhaled
Spontaneous tidal volume adjusted for patient weight exhaled
Mandatory tidal volume exhaled
Mandatory tidal volume adjusted for patient weight exhaled
Vdel
This is the uncorrected tidal volume measured by the inspiratory flow sensor inside the ventilator.
Leak
Percent leakage
L
Total Ve
Minute Volume
ml/kg
Total Ve/kg
L
Spon Ve
ml/kg
Spon Ve/kg
bpm
Rate
Minute volume adjusted for patient weight
Spontaneous minute volume
Spontaneous minute volume adjusted for patient weight
Total Breath Rate (spontaneous and mandatory)
bpm
Spon Rate
Spontaneous breath rate
bpm
Mand Rate
Mandatory Breath Rate
sec
Ti
Inspiratory time
sec
Te
Expiratory Time
I:E
Inspiratory/expiratory ratio
B2/Min/L
Rapid shallow breathing index
f/Vt
cmH2O
Ppeak
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Chapter 4 Monitors, Displays and Maneuvers
Display
Value
cmH2O
Pmean
Mean inspiratory pressure
cmH2O
Pplat
Plateau pressure
cmH2O
PEEP
Positive end expiratory pressure
psig
Air Inlet
Air inlet pressure
psig
O2 Inlet
Oxygen inlet pressure
%
FiO2
Percentage of oxygen
ml/cmH2O
Cdyn
Dynamic compliance
ml/cmH2O
Cdyn/Kg
Dynamic compliance adjusted for patient weight
ml/cmH2O
Cstat
Respiratory system compliance (Static compliance)
ml/cmH2O
Cstat/Kg
Respiratory system compliance adjusted for patient weight (Static compliance
F/Vt
cmH2O/LPS
Rrs
AVEA Ventilator Systems
Rapid Shallow Breathing Index (f / Vt) which is the spontaneous breath rate per tidal volume
Respiratory system resistance
L/min
PIFR
Peak Inspiratory flow rate
L/min
PEFR
Peak Expiratory flow rate
C20/C
Ratio of the dynamic compliance during the last 20% of inspiration (C20) to the total dynamic compliance (C).
CCW
CLUNG
RRS
Chest wall Compliance (CCW), is the ratio of the tidal volume (exhaled) to the Delta Esophageal Pressure (dPES).
Lung Compliance (CLUNG), is the ratio of the tidal volume (exhaled) to the delta transpulmonary pressure
Respiratory System Resistance (RRS), is the total resistance during the inspiratory phase of a breath
RPEAK
Peak Expiratory Resistance (RPEAK) is defined as the resistance at the time of the Peak Expiratory Flow (PEFR).
RIMP
Imposed Resistance (RIMP), is the airway resistance between the wye of the patient circuit and the tracheal sensor
RLUNG
Lung Resistance (RLUNG), is the ratio of the tracheal pressure differential to the inspiratory flow 12 ms prior to the end of inspiration
PIFR
The actual peak inspiratory flow rate for the inspiratory phase of a breath.
PEFR
The actual peak expiratory flow rate for the expiratory phase of a breath.
dPAW
Delta Airway Pressure (dPAW), is the difference between peak airway pressure and baseline airway pressure.
dPES
Delta Esophageal Pressure (dPES), is the difference between peak esophageal pressure and baseline esophageal pressure
AutoPEEP
AutoPEEP, is the airway pressure at the end of an expiratory hold maneuver.
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Chapter 4 Monitors, Displays and Maneuvers
Display
Value
dAutoPEEP
Delta AutoPEEP (dAutoPEEP), is the difference between airway pressure at the end of an expiratory hold maneuver and the airway
pressure at the start of the next scheduled breath after the expiratory hold maneuver
AutoPEEPES
AutoPEEPES is the difference between esophageal pressure measured at the end of exhalation minus the esophageal pressure
measured at the start of a patient-initiated breath and the sensitivity of the ventilator’s demand system
Ptp Plat
Transpulmonary pressure during an inspiratory hold
MIP
Maximum Inspiratory Pressure is the maximum negative airway pressure that is achieved by the patient, during an expiratory hold
maneuver
P100
Respiratory Drive (P100), is the negative pressure that occurs 100 ms after an inspiratory effort has been detected
WOBV
Ventilator Work of Breathing (WOBV), is the summation of airway pressure minus the baseline airway pressure times the change in
tidal volume to the patient during inspiration, and normalized to the total inspiratory tidal volume
WOBP
Patient Work of Breathing (WOBP), normalized to the total inspiratory tidal volume
WOBI
Imposed Work of Breathing (WOBI), is defined as the work performed by the patient to breathe spontaneously through the
breathing apparatus, i.e. the E.T. tube, the breathing circuit, and the demand flow system.
Ptp PEEP
Ptp Plat
Transpulmonary pressure, AutoPEEP (PtpPEEP) is the difference between the corresponding airway and the esophageal pressures
at the end of the expiratory hold during an AutoPEEP maneuver.
The ventilator is capable of calculating and displaying the Transpulmonary pressure during an inspiratory hold, which is the
difference between the airway plateau pressure (Pplat aw) and the corresponding esophageal pressure.
Events
Pressing the EVENT membrane button to the left of the
touch screen opens a scrollable menu of event markers that
are placed in the trend buffer along with the 34 monitored
parameters. To select an event use the data dial to scroll
the event menu and highlight the desired event. Press the
ACCEPT button adjacent to the data dial to place the event
in the trend buffer. Events will appear on the data
spreadsheet in green text with an asterisk next to the time
code (see Trends discussion below).
Figure 4.6 The Events menu
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Selectable events include:
Event
Abbreviation
Blood Gas
BG
Chest X-ray
CXR
Diagnostic (Dx) Procedure
Dx
Feeding
Feed
Intubation
ETT
Therapeutic (Rx) Procedure
Rx
Suction
Sxn
The following events are automatically recorded in the event log:
Event
Abbreviation
Change a primary or advanced control setting
Stgs
Powering the ventilator on
Pon
Powering the ventilator off
Poff
Entering Standby
eSby
exiting Standby
xSby
Activation of the nebulizer
Neb
Activation of the expiratory hold
eHold
Activation of the inspiratory hold
iHold
A manual breath
Man
Activation of the suction button
Sxn
Activation of the increase O2 button
IncO2
Activation of New Patient
NwPt
Involuntary Power Loss & Recovery
Prec
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Trends
The monitored parameters described in the previous section are trended as one minute averaged values over a running
24-hour period. Trend data is accessed by pressing the screen button on the membrane panel to the left of the touch
screen or by pressing the screen indicator in the top center portion of the touch screen display. The screen menu will
appear. Press the TREND button on the screen menu to open the trends screen.
Figure 4.7 The Trends Window
Note
If left open the Trends Window will update every 10 minutes.
Four histograms and a spreadsheet are displayed on the touch screen. Each histogram and column on the spreadsheet
can be configured from the list of monitored parameters as well as events. Touch the title bar of any histogram or the
heading of any column to open a scrollable menu. Move through the list by turning the data dial. Highlight the item to be
displayed and press the highlighted display or the ACCEPT button above the data dial to accept the new item for display.
Histograms can be scaled by touching either axis. With the axis highlighted, use the data dial to adjust the scale. Touch
the axis again or press the ACCEPT button to accept the change.
To look at histogram or spreadsheet trends over time, press the FREEZE button and use the data dial to move the
cursor through the time line. The time line is shown as yellow text on the spreadsheet. Event markers appear in green
text.
Note
Changing the date / time back on the instrument’s internal clock erases stored trend data.
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Main Screen Displays
Calculated I:E Ratio
The AVEA displays the calculated I:E Ratio (Calc I:E) based on the set breath rate, set tidal volume, and set peak flow
for Volume breaths, or the set breath rate and set inspiratory time for Pressure, TCPL, and PRVC breaths. The display
is located next to the Calculated Minute Volume display at the bottom left of the Main screen.
Range:
1:99.9 to 99.9:1
Limitations: For Volume breaths, the calculated I:E Ratio shall only change if the set tidal volume, set breath rate,
or set peak flow is changed. For Pressure, TCPL, PRVC, breaths, the calculated I:E Ratio shall only
change if the set breath rate or set inspiratory time is changed.
Note
Calculated I:E ratio is not active in APRV / BIPHASIC mode
Calculated Minute Volume (Calc Ve)
The ventilator displays the Calculated Minute Volume at the bottom left of the Main screen as follows:
Calc Ve = [(Set tidal volume) × (Set breath rate)]
Limitation:
For Volume breaths only. The Calc Ve display only changes if the set tidal volume or set breath rate is
changed.
Calculated Time High & Time Low Min / Max
The AVEA displays the calculated minimum and maximum Time High and Time Low in APRV / BiPhasic ventilation. The
display is located immediately under the Time High and Time Low primary controls on the main screen.
Min
Max
Min
Max
Note
Time High and Time Low are maximum time settings for a time-cycled transition. Actual times may vary depending on
the patient’s spontaneous breathing pattern and the Sync window setting.
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Chapter 4 Monitors, Displays and Maneuvers
Main Screen Monitors
Five monitored parameters are continuously displayed to the left of the graphic displays. These are selected in the same
way as the displays on the Monitors screen.
1.
Use the touch screen to select and highlight the monitor you wish to set.
2.
Turn the data dial beneath the touch screen to scroll through the menu choices.
3.
To accept your selection, either touch the highlighted display or press the accept button adjacent to the
data dial.
Highlighted
Parameter
Selection Menu
for Monitored
Parameter
Figure 4.8 Selectable Monitored Parameters Displayed on the Main Screen
Note
The main screen monitored parameters may be different than the monitored parameters on the loops or trends screens.
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Chapter 5 Infant NCPAP
Overview
Infant Nasal CPAP is a spontaneous mode of ventilation. In this mode, no mechanical positive pressure breaths are
delivered and no inspiratory triggers are required. A patient spontaneously breathes at an elevated baseline pressure
level called the “nCPAP level.”
Note
Nasal CPAP is an available option in the Infant Mode Select Screen only.
Circuit Compatibility
AVEA nCPAP utilizes standard two-limbed neonate patient circuits and nasal prongs for the patient interface.
The following nasal CPAP prongs have been approved for use:
ƒ
HUDSON Infant Nasal CPAP Cannula: Sizes 0 through 4
Hudson RCI, Research Triangle NC
ƒ
INCA® Infant Nasal Cannula: Sizes 7.5F, 9F, 10.5F, 12F, 15F
CooperSurgical, Inc., Trumbull CONN
ƒ
NEOTECH Binasal Airway: Sizes 3.0 mm, 3.5 mm, 4.0 mm
NEOTECH Products, Inc., Valencia CA
ƒ
ARGYLE® Infant Nasal Cannula: Sizes Extra-small, Small, Large
Sherwood Medical; St. Louis MO
General Specifications
nCPAP Level
Range
2 to 10 cmH2O
Resolution
1 cmH2O
Default
2 cmH2O
Accuracy
± 2 cmH2O
nCPAP Flow
Flow delivery is under software control and limited to a maximum of 15LPM.
Advanced Settings
There are no advanced settings for the primary settings in Nasal CPAP.
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Alarms
The Alarms Settings Screen does not open in Nasal CPAP.
Existing machine alarms and safety systems will be maintained. During nCPAP support,
certain alarms will be suspended.
Alarms suspended during nCPAP
Time Based Alarms
High Rate
I-Time Limit
I:E Limit
Apnea Interval
Volume Based Alarms
High Ve
High Vt
Low Vte
Low Ve
Volume Limit
Pressure Alarms
High Ppeak
High Ppeak sustained
Low PEEP
Low Ppeak
Occlusion
Alarms added during nCPAP
High nCPAP Pressure
A high priority audible/visual alarm is activated whenever the nCPAP Pressure exceeds the threshold for a period greater
than 15 seconds.
Alarm threshold is automatically updated on acceptance of control setting.
Threshold:
Set nCPAP level + 3 cmH2O or Pressure Limit
Low nCPAP Pressure
A high priority audible/visual alarm is activated whenever the nCPAP Pressure falls below the threshold for a period
greater than 15 seconds.
Alarm threshold is automatically updated on acceptance of control setting.
Threshold:
Set nCPAP level -2 cmH2O (If nCPAP setting ≥ 3 cmH2O)
Set nCPAP level -1 cmH2O (if nCPAP setting < 3 cmH2O)
nCPAP Pressure Limit
A high priority audible/visual alarm will be activated if the nasal CPAP pressure exceeds 11 cmH2O for 3 seconds. Upon
activation of the alarm, the safety valve will open to ambient. The alarm will deactivate and the safety valve will close
when the nCPAP pressure falls below 4.5 cmH2O.
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Initiating Nasal CPAP
1. To initiate Nasal CPAP, touch the Modes membrane button on the UIM or touch the screen area for the Current Mode
Display. The Mode Select box appears
Figure 1 Mode selection
2. Touch Nasal CPAP. The following message appears.
Figure 2 Calibration Required Message
3. Disconnect the Nasal CPAP device from the patient and disconnect the expiratory limb of the circuit at the patient wye. (See
Figure 3)
Figure 3 Disconnect Point for Calibration
Do not disconnect the Nasal CPAP device at the wye and leave the prongs open to ambient.
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Chapter 5 Infant NCPAP
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4. Touch Continue; the following message appears.
Figure 4 Calibration Progress Message
If calibration is successful, the following message appears.
Figure 5 Calibration Successfully Completed Screen
Note
If the calibration test fails, check the following:
ƒ
Ensure the patient was disconnected during the calibration.
ƒ
Ensure the circuit connections are secure.
ƒ
Ensure there was no movement of the circuit during the calibration.
ƒ
Ensure the prongs are open during the test.
ƒ Ensure the expiratory limb of the circuit was disconnected before starting the calibration.
If failure of the calibration persists after checking all of the above, remove the ventilator from service and have it checked by a
qualified technician.
5. Reconnect the expiratory limb of the circuit at the patient wye.
6. Connect the Nasal CPAP device to the patient and touch Continue. The patient will be supported initially by the default value
of 2 cmH2O of continuous positive airway pressure.
7. Set the prescribed level for nCPAP Pressure and/or FiO2 by touching the primary control, turning the Data Dial until the
desired value is displayed and by either touching the primary control again or by touching the ACCEPT membrane key
adjacent to the Data Dial to activate the new setting.
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5-5
Note
Low Nasal CPAP Pressure and High Nasal CPAP Pressure Alarm Thresholds are updated automatically when a new
value is accepted in the nCPAP Primary Control.
Figure 6: nCPAP Primary Controls and Alarm Threshold Indicators
CAUTION!
Apnea back-up ventilation is suspended during nCPAP.
AVEA continually displays the following message during nCPAP administration.
Figure 7: Caution Message Display
Monitors
In Nasal CPAP, all existing monitors will be suspended, except:
ƒ
Air Inlet Pressure (Air Inlet)
ƒ
Oxygen Inlet (O2 Inlet)
ƒ
Gas Composition Monitor (FiO2)
ƒ
Percent Leak
The following monitors have been added for Nasal CPAP:
ƒ
nCPAP level (mean airway pressure)
Range:
0 to 120 cmH2O
Resolution: 1 cmH2O
Accuracy:
ƒ
±3.5% of reading or ±2 cmH2O, whichever is greater
CPAP Flow (mean inspiratory flow)
Range:
0–300 LPM
Resolution: 0.1 LPM
Accuracy:
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Chapter 5 Infant NCPAP
AVEA Ventilator Systems
Graphics
All existing waves will be maintained except for the volume (Vt) wave will be selectable with no functionality and the
loops selection button will be disabled.
Displayed Waves
ƒ
Net Flow (Flow)
Range:
ƒ
Minimum:
-2 to +2 LPM
Maximum:
-300 to +300 LPM
Default:
-40 to +40 LPM
Inspiratory Flow / CPAP Flow (Finsp)
Range:
ƒ
ƒ
ƒ
Minimum:
-2 to +2 LPM
Maximum:
-300 to +300 LPM
Default:
-20 to +20 LPM
Expiratory Flow (Fexp)
Minimum:
-2 to +2 LPM
Maximum:
-300 to +300 LPM
Airway Pressure / CPAP Level (Paw)
Minimum:
-1 to +2 cmH2O
Maximum:
-60 to +120 cmH2O
Default:
-20 to +40 cmH2O
Inspiratory Pressure (PINSP)
Minimum:
-1 to +2 cmH2O
Maximum:
-60 to +120 cmH2O
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Chapter 5 Infant NCPAP
Messages
AVEA Message Bar Text
Cause
"Characterization is Required in Nasal CPAP."
Mode Key pressed when nasal CPAP
characterization is in progress.
"No Advanced Settings in Nasal CPAP."
Advanced Settings Screen Button was
pressed.
"No Alarm Limits in Nasal CPAP."
Alarm Limits Screen Button was pressed.
"No Manual Breath in Nasal CPAP."
Manual Breath Button was pressed.
"No Proximal Flow Sensing in nCPAP."
On detection of a Proximal Flow Sensor in
Nasal CPAP Mode.
Troubleshooting
Alarm
Priority
Possible Causes
Actions
NCPAP Pressure
Limit
High
Occlusion of expiratory limb
of patient circuit.
Occluded expiratory filter
Check expiratory limb for
kinks and/or water
Replace expiratory filter
Low NCPAP
Pressure
High
Circuit disconnect
Circuit leak
Patient interface leak
Check circuit
Check patient interface
High NCPAP
Pressure
High
Patient circuit occlusion
Water in circuit
Patient interaction
Check patient circuit
Check nasal prongs
Circuit Disconnect
High
Patient circuit disconnect
Check patient circuit
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Chapter 6 Alarms and Indicators
Status Indicators
The ventilator displays the following status indicators.
Compressor Active
If the internal compressor is active, the Compressor Active icon shown here will display at the bottom of the touch
screen with no accompanying tone.
Heliox Source Connected
If Heliox gas is connected this green icon displays in bottom right of the touch screen.
Mains/Battery Indicators
There are visual status indicators on the ventilator front panel for the mains power and the internal and external batteries
(Figure 5.1).
The sequence in which the power sources are used by the ventilator is:
Mains AC Power
External Battery (if installed)
Internal Battery
Power On Indicator
The green Power On indicator lights up whenever the power switch is on ( I ) and power is being supplied from any of the
available power sources (AC, external battery, or internal battery).
On battery indicator while operating on internal or external battery, a battery icon will blink in the lower right hand corner
of the display.
AC Power Indicator
The green AC indicator is on whenever the ventilator is connected to AC power. It displays whether the power switch
is on ( I ) or off (O).
Operating On Battery Indicator
When operating on battery power (Internal or External) a yellow blinking battery indicator will appear in the lower right
hand corner of the LCD screen.
External Battery Power Indicator
The EXT indicator above the battery status indicators is lit whenever the external battery is providing the primary source
of power for the ventilator.
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Internal Battery Power Indicator
The INT indicator above the battery status indicators is lit whenever the internal battery is providing the primary source of
power for the ventilator.
Battery Status Indicators
The battery status indicator shown in figure 5.1 for the INTernal or optional EXTernal battery will illuminate incrementally
depending on the available charge remaining in the battery.
Note
If the ventilator is plugged into the mains power supply and no battery status light is illuminated for the internal battery or
optional external battery (if equipped), the battery should be checked and/or replaced. Replacement of the Internal
battery must be done by a VIASYS trained technician.
Green (80% or more charge remaining for external battery, 90% or more charge remaining for the internal battery),
Yellow (Less than 80% for external battery, 90% for the internal battery)
Red (less than 40% for external battery, 30% for the internal battery)
Note
When approximately 2 minutes of battery charge remain the ventilator will initiate a non-cancelable alarm. The ventilator
should be immediately connected to an appropriate AC power source.
A/C Indicator
GREEN
YELLOW
RED
Figure 5.1 Front Panel Display Area. Comprehensive model shown.
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Messages
The AVEA displays messages in one of two ways.
In a “Popup” message box
In the Message bar at the bottom right of the touch screen
Alert Messages that require an acknowledgement from the user, appear in a “pop-up” message box with an “OK” or
“Continue” button. When you press the acknowledgement button, the message disappears and the ventilator continues
normal functioning.
“Popup” Alert Messages
These messages will require you to press a button to clear the “Popup” box.
Can't change Mode to APRV / BiPhasic when ILV is active.
Can't set Pres Low higher than Pres High.
Can't set Pres High lower than Pres Low.
Stored Settings and Configuration Data lost.
Settings restored to defaults. Check Barometric Pressure .setting.
Stored Settings lost. Settings restored to defaults.
Stored Configuration Data lost. Check Barometric Pressure setting.
Can't change size to PED or ADULT when Mode is TCPL.
Can't change size to NEO when Mode is PRVC.
Can't change size to NEO when Mode is APRV / BiPhasic.
Can't change patient size when Machine Volume is active.
ILV is not available when Mode is APRV / BiPhasic.
Can't disable O2 Alarms when Heliox is in use.
Ppeak > 90cmH2O
The Message Bar
Messages not requiring acknowledgement or response appear in the Message Bar located at the bottom right of the
touch screen. A complete list of text, with explanations, for those messages that appear in the message bar, is provided
in Appendix F.
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Alarms
Alarm Categories
AVEA ventilator alarms are grouped into three categories:
High priority (warning)
This category of alarm requires immediate action. For a high priority alarm, the alarm indicator is RED and the alarm icon
flashes at a rate of 2 Hz (fast). A high priority alarm sounds a series of five tones, three low and two high, repeated at
intervals of 6 seconds.
Medium priority (caution)
A medium priority alarm displays a yellow indicator and the alarm icon flashes at ½ Hz (slow). A medium priority alarm
sounds three tones, all at the same pitch, repeated at intervals of 20 seconds.
Low priority (advisory)
A low priority alarm (or advisory) displays a yellow indicator and the alarm icon does not flash.
A low priority alarm sounds a single tone, which is not repeated
There are visual displays for all categories of alarms. A text message appears in the indicator at the upper right of the
touch screen.
The alarm icons flash until the cause of the alarm is no longer present. Both high and medium priority alarms that have
been resolved will appear as a solid yellow message indicator with no icon displayed until the Alarm Reset button is
pressed. (See table 5.1 for alarm messages).
Multiple alarms can be displayed simultaneously. If 2 or more alarms are current, a white triangle appears on the right of
the alarm indicator/message. Touching the screen over the triangle will open a drop down box for display of up to nine
alarm messages. In the event that there are more than nine active or resolved alarms available for display, the nine
highest priority alarms will be displayed.
To close the drop down box and display a single alarm message, touch the triangle again.
Alarm messages are prioritized in order of appearance, the highest priority alarm is always displayed in the top position
of the alarm indicator display.
The alarm indicator is solid green with no message when no alarms are currently active.
Backup Alarm (advisory)
A continuous tone alarm sounds when a vent-inop occurs and the Back Up Alarm electronics detects the primary alarm
is not functioning.
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Alarm Controls
Setting an Alarm Limit
To set the limits for each alarm, press the red Alarm
LIMITS membrane button on the right of the user
interface marked with the icon shown here.
The Alarm Limits screen will appear (see figure 5.2). To set the limits for an alarm, press the touch screen immediately
over the alarm control. The control will highlight (change color) on the screen.
Figure 5.2 Alarm Limits Screen
With the control selected, rotate the large data dial below the touch screen until
the control reaches the setting you require. To accept the new setting, either
press the touch screen over the control again or press the ACCEPT button.
Note:
Red indicators appearing on the primary controls display the relative alarm settings of any associated alarm.
Alarm Silence
You can disable the audible alarm for 2 minutes ± 1 second by pressing the Alarm Silence key. Pressing the Alarm
Silence key again before the 2-minute period is up will cancel the “silence”. This feature is functional for all alarms, with
the exception of the “Vent Inop” alarm, which cannot be silenced.
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Chapter 6 Alarms and Indicators
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Note
The activation of the auditory alarm silence button will not prevent the subsequent activation of auditory alarm signals for
certain alarm conditions.
Alarm Reset
The Alarm Reset button deactivates visual indicators for alarms that are no longer active.
Alarm Types
Machine Alarms
Safety Valve Open
This is a high priority audible/visual alarm. SAFETY VALVE OPEN is displayed, and a high priority tone sounds
whenever the Safety Valve is open.
Ventilator Inoperative
This is a high priority audible/visual alarm. VENT INOP is displayed if the ventilator fails due to a non-recoverable
condition, such as loss of power or supply gases. A high priority tone sounds. The safety valve opens, indicated by a
SAFETY VALVE OPEN alarm message, and the patient is allowed to breathe room air.
Note
PEEP is not maintained during a VENT INOP or a SAFETY VALVE OPEN alarm condition. When the ventilator safety
valve is open the ventilator graphics will indicate a safety state by displaying the color purple.
Fan Failure
This is a low priority audible/visual alarm. FAN FAILURE is displayed and low priority tone sounds, whenever the
circulating fan at the rear of the ventilator cabinet stops rotating.
Circuit Disconnect Alarm
This is a high priority audible / visual alarm. The ventilator will sound a disconnect alarm when total expiratory flow,
inclusive of bias flow is less than 10% of total inspiratory flow, inclusive of bias flow for 5 seconds. Additionally, in
neonatal applications when a proximal flow sensor is used the circuit disconnect is sounded when the Percent Leak
((Vti – Vte) /Vti) is greater than 95% for three consecutive breaths.
Note
While the circuit disconnect alarm is active, the ventilator will stop cycling and set a bias flow. The ventilator will
automatically detect the patient upon reconnection and resume normal ventilation.
The apnea interval timer is suspended during a Patient Circuit Disconnect Alarm.
Setting extremely small delivered tidal volumes with Circuit Compliance Compensation not active and using a proximal
flow sensor may result in assertion of Patient Circuit Disconnect Alarms.
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Gas Supply Indicators and Alarms
Loss of Air
This is a high priority audible/visual alarm. LOSS, AIR is displayed and a high priority tone sounds. This alarm is
triggered if the wall air supply to the ventilator drops below 18.0 psig (1.2 bar), and the ventilator does not have a
functional internal compressor or the compressor output is insufficient to meet instrument demand. The patient
continues to be ventilated by the oxygen supply only.
Loss of O2
This is a high priority audible/visual alarm. LOSS, O2 is displayed and a high priority tone sounds. This alarm is
triggered if the oxygen supply to the ventilator drops below 18.0 psig (1.2 bar) and the % O2 control is set >21%. The
patient continues be ventilated by the air supply (wall air or internal compressor) only.
Loss of Gas Supply
This is a high priority audible/visual alarm. LOSS, GAS SUPPLY is displayed and a high priority tone sounds. This
alarm is triggered if the ventilator loses all sources of gas (wall air, internal compressor if present, and wall oxygen). The
safety valve opens, indicated by a SAFETY VALVE OPEN visual display, and the patient is allowed to breathe room air.
Note
PEEP is not maintained during a LOSS, GAS SUPPLY alarm condition. When the ventilator safety valve is open the
ventilator graphics will indicate a safety state by displaying the color purple.
Loss of Heliox
This is a high priority audible/visual alarm. LOSS, HELIOX is displayed and a high priority tone sounds. The alarm is
triggered if Heliox is being used and the Heliox supply to the ventilator drops below 18.0 psig (1.2 bar). The patient
continues to be ventilated by the oxygen supply only.
Pressure Alarms
Low Peak Pressure
This is a high priority audible/visual alarm. LOW PPEAK is displayed and a high priority tone sounds, whenever the peak
inspiratory pressure for a given breath is less than the preset threshold for Low PPEAK.
Range:
3 to 99 cmH2O
Defaults:
8 cmH2O (Adult/Pediatric)
5 cmH2O (Neonate)
Limitations:
Not active for spontaneous breaths.
High Peak Pressure
This is a high priority audible/visual alarm. HIGH PPEAK is displayed and a high priority tone sounds whenever the preset
High PPEAK threshold is exceeded. Inspiration is terminated and circuit pressure is allowed to return to the current set
baseline pressure + 5 cmH2O. Circuit pressure must return to baseline +5 cmH2O before the next breath can be
delivered.
Normal High PPEAK Alarm
Alarms if the inspiratory pressure in the patient circuit exceeds the set High PPEAK alarm threshold during the
inspiratory phase of a breath, except during sigh breath cycles.
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Chapter 6 Alarms and Indicators
Range:
AVEA Ventilator Systems
10 to 105 cmH2O (Adult/Pediatric)
10 to 85 cmH2O (Neonate)
Defaults:
40 cmH2O
(Adult/Pediatric)
30 cmH2O
(Neonate)
Not active for Sigh Breaths
Sigh High PPEAK Alarm
Alarms if the inspiratory pressure in the patient circuit exceeds the Sigh High PPEAK alarm threshold during a
sigh breath cycle.
Range:
1.5 x (Normal High PPEAK), up to a maximum of 105 cmH2O
Active only for Sigh Breaths.
Note
Maximum Circuit Pressure Limit:
The ventilator has an independent mechanical pressure relief valve, which limits the maximum pressure at the patient
wye to 125 cmH2O.
Extended High Peak Pressure
This is a high priority audible/visual alarm. EXT HIGH PPEAK, is displayed and a high priority tone sounds if the High PPEAK
alarm remains active for more than 5 seconds, (i.e. the circuit pressure does not return to PEEP + 5 cmH2O within 5
seconds). No breaths are delivered during this alarm condition. The Safety and Exhalation valves open allowing the
patient to breathe from room air and the Safety Valve alarm activates. Bias flow is suspended while this alarm is active.
PEEP may not be maintained. This alarm remains active (flashing) until the condition causing it has been resolved.
Low PEEP
This is a high priority audible/visual alarm. LOW PEEP is displayed and a high priority tone sounds if the baseline
pressure (PEEP) is less than the Low PEEP alarm threshold for a period greater than 0.25 ± 0.05 seconds.
Range:
0 to 60 cmH2O
Defaults:
3 cmH2O
(Adult/Pediatric)
1 cmH2O
(Neonate)
The alarm is off if set to zero.
Circuit Occlusion Alarm
This is a high priority audible/visual alarm. CIRCUIT OCCLUSION is displayed and a high priority tone sounds whenever
the pressure level in the inspiratory limb of the circuit exceeds the expiratory pressure level by greater than 6 cmH2O for
more than 200msec in neonatal and pediatric applications and greater than 9 cmH2O for more than 200msec in adult
applications. Inspiration is terminated and the circuit pressure is allowed to return to the current set baseline pressure +5
cmH2O. Circuit pressure must return to baseline +5 cmH2O before the next breath can be delivered. In adult
applications the circuit occlusion alarm is suspended during the first 150 msec of exhalation.
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Volume Alarms
Low Exhaled Minute Volume (Low Ve)
This is a high priority audible/visual alarm. LOW MINUTE VOLUME is displayed and a high priority tone sounds
whenever the monitored exhaled minute volume is less than the Low Exhaled Minute Volume threshold setting.
Range:
Off (indicated by 0), 1 to 50 L
(Adult)
Off (indicated by 0), 0.1 to 30.0 L
(Pediatric)
Off (indicated by 0), 0.01 to 5.00 L (Neonate)
Defaults:
1.00 Liter (Adults)
0.50 Liter (Pediatrics)
0.05 Liter (Neonate)
High Exhaled Minute Volume (High Ve)
This is a medium priority audible/visual alarm. HIGH MINUTE VOLUME is displayed and a medium priority tone sounds
whenever the monitored exhaled minute volume is greater than the High Exhaled Minute Volume threshold setting.
Range:
Defaults:
0 to 75 L
(Adult)
0.0 to 30.0 L
(Pediatric)
0.00 to 5.00 L
(Neonate)
30.0 L
(Adult/Pediatric)
5.00 L
(Neonate)
Low Exhaled Tidal Volume (Low Vt)
A high priority audible/visual alarm shall be activated, and LOW TIDAL VOLUME shall be indicated, whenever the
absolute monitored exhaled tidal volume does not exceed the Low Tidal Volume alarm threshold setting for the Low Vte
Sensitivity setting.
Range: Off (indicated by 0.00) to 3.00 L
Off (indicated by 0) to 1000 mL
(Adult)
(Pediatric)
Off (indicated by 0.0) to 300.0 mL (Neonate)
Resolution:
0.01 L (Adult)
1 mL
(Pediatric)
0.1 mL (Neonate)
Accuracy:
± 0.01 L of monitored exhaled tidal volume (Adult)
± 1 mL of monitored exhaled tidal volume
(Pediatric)
± 0.1 mL of monitored exhaled tidal volume (Neonate)
Defaults:
0.00 L (Adult)
0 mL
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Chapter 6 Alarms and Indicators
AVEA Ventilator Systems
0.0 mL (Neonate)
Note
The Low Exhaled Tidal Volume alarm will assert on a single occurrence of a low exhaled volume. In patients who have
variable tidal volumes, the Low Exhaled Tidal Volume alarm may be turned off (default) and the Low Exhaled Minute
Volume alarm can be used to avoid nuisance alarms.
High Tidal Volume (High Vt)
This is a low priority audible/visual alarm.. HIGH Vt is displayed and a low priority tone sounds if the absolute monitored
exhaled tidal volume is greater than the High Tidal Volume threshold setting.
Range:
Defaults:
0.10 to 3.00 L
(Adult)
25 to 1000 ml
(Pediatric)
2.0 to 300.0 ml
(Neonate)
3.00 L
(Adult)
1000 ml
(Pediatric)
300.0 ml
(Neonate)
Rate/Time Alarms
Apnea Interval
This is a high priority audible/visual alarm. APNEA INTERVAL is displayed and a high priority tone sounds if the
ventilator does not detect a breath initiation (by any means) within the preset period of time. Apnea ventilation will begin
when this alarm is activated.
Range:
6 to 60 seconds
Default:
20 seconds
High Rate
This is a medium priority audible/visual alarm. HIGH RATE is displayed and a medium priority tone sounds if the
monitored total breath rate exceeds the alarm setting.
Range:
1 to 200 bpm
Default:
75 bpm
Maximum Inspiratory Time Limit (Max I-Time)
This is a low priority audible/visual alarm. I-TIME LIMIT is displayed and a low priority tone sounds if the inspiratory time
for any breath exceeds the maximum set inspiratory time plus pause time. Maximum inspiratory time is 5.0 seconds for
adult/pediatric, and 3.0 seconds for neonate. The inspiratory phase of the breath is terminated when this alarm
activates.
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I:E Ratio Limit (I:E Limit)
This is a low priority audible/visual alarm. I:E LIMIT is displayed and a low priority tone sounds, if the I:E Ratio for a
mandatory breath exceeds 4:1. The inspiratory phase of the breath is terminated when this alarm activates.
This alarm is not active in APRV / BIPHASIC mode.
O2 Alarms
Low O2% (Low FiO2)
This is a high priority audible/visual alarm. LOW FiO2 is displayed and a high priority tone sounds if the monitored
Delivered O2% falls below the set FiO2 minus 6% or 18% FiO2, whichever is greater.
High O2% (High FiO2)
This is a high priority audible/visual alarm. HIGH FiO2 is displayed and a high priority tone sounds if the monitored
Delivered O2% rises above the set FiO2 + 6%.
Table 5.1 Alarm Conditions
Message
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Alarm Condition
Range
Priority
SAFETY VALVE
OPEN
Safety valve is open
N/A
High
VENT INOP
Ventilator failure due to a recoverable or non-recoverable
condition. The safety valve opens, indicated by a SAFETY
VALVE message, and the patient is allowed to breathe room
air. PEEP is not maintained
N/A
High
LOSS, AIR
Wall air drops below 18.0 psig (1.2 bar) and no functional
compressor is installed or the compressor output is insufficient
to meet instrument demand. Patient will continue to be
ventilated by O2 supply only.
N/A
High
LOSS, O2
Oxygen supply to the ventilator drops below 18.0 psig (1.2 bar)
and the %O2 is set to > 21%. Patient will continue to be
ventilated by the air supply only
N/A
High
LOSS, HELIOX
The alarm is triggered if heliox is being used and the heliox
gas supply to the ventilator drops below 18.0 psig (1.2 bar).
The patient continues to be ventilated by the oxygen supply
only.
N/A
High
LOSS, GAS
SUPPLY
All sources of gas fail; wall air, internal compressor (if
installed) and oxygen. The safety valve opens, indicated by a
SAFETY VALVE OPEN message, and the patient is allowed to
breathe room air. PEEP is not maintained.
N/A
High
LOW PPEAK
The peak inspiratory pressure for a breath is less than the set
LOW PPEAK. Not active for spontaneous breaths.
3 to 99 cmH2O
Default 3 cmH2O
High
HIGH PPEAK
Peak inspiratory pressure is greater than the set HIGH PPEAK.
Inspiration is terminated and the circuit pressure is allowed to
return to baseline pressure + 5 ± 1.5 cmH2O before the next
breath is delivered.
Normal Breath Range:
Adult:
10 to 105 cmH2O
Default: 40 cmH2O
Pediatric:
10 to 85 cmH2O
Default: 40 cmH2O
Neonate:
Default: 30 cmH2O
Sigh Breath Range:
1.5 x set normal HIGH PPEAK
Only active for sigh breaths
High
6-12
Chapter 6 Alarms and Indicators
Message
AVEA Ventilator Systems
Alarm Condition
Range
Priority
EXT HIGH PPEAK
Activates whenever the HIGH PPEAK alarm has been active for
more than 5 seconds (i.e. If the circuit pressure fails to return
to PEEP + 5 cmH2O within 5 seconds). The safety and
exhalation valves open and no breaths are delivered. The
SAFETY VALVE OPEN alarm activates. Bias flow is
suspended while this alarm is active. PEEP may not be
maintained. This alarm will remain active until the condition is
resolved.
N/A
High
LOW PEEP
Baseline pressure (Positive End Expiratory Pressure) is less
than the set LOW PEEP alarm threshold for a period greater
than 0.25 ± 0.05 seconds. This alarm is OFF if set to zero.
0 to 60 cmH2O
Defaults:
3 cmH2O (Adult/Pediatric)
1 cmH2O (Neonate)
High
LOW Ve
Monitored exhaled minute volume (Ve) is less than the set
LOW Ve alarm threshold.
OFF (0), 1 to 50 L (Adult)
OFF (0), 0.1 to 30 L (Pediatric)
OFF (0), 0.01 to 5.00 L (Neonate)
Default OFF
Medium
HIGH Ve
Monitored exhaled minute volume (Ve) is greater than the set
HIGH Ve alarm threshold.
0 to 75 L (Adult)
0.0 to 30.0 L (Pediatric)
0.00 to 5.00 L (Neonate)
Defaults:
30.0 L (Adult/Pediatric)
5.00 (Neonate)
Medium
HIGH Vt
The absolute monitored exhaled tidal volume is greater than
the set HIGH Vt alarm threshold.
0.10 to 3.00 L (Adult)
25 to 1000 ml (Pediatric)
2.0 to 300.0 ml (Neonate)
Defaults:
3.00 L (Adult)
1000 ml (Pediatric)
300.0 ml (Neonate)
Visual Alert
Low Vt
The absolute monitored exhaled tidal volume does not exceed
the Low Tidal Volume alarm threshold setting
Off to 3.00 L (Adult)
Off to 1000 mL (Pediatric)
Off to 300.0 mL (Neonate)
High
APNEA
INTERVAL
Active in A/C, SIMV, APRV / BIPHASIC and CPAP/PSV
modes if the ventilator does not detect a breath within the
preset APNEA time interval.
6 to 60 seconds
Default 20 seconds
High
HIGH RATE
The monitored total breath rate exceeds the set alarm RATE.
1 to 200 bpm
Default: 75 bpm
Medium
I-TIME LIMIT
The inspiratory time for a breath exceeds the set MAX I-TIME
plus pause time, which is 5.0 seconds for adult/pediatric
patients and 3.0 seconds for neonatal patients.
N/A
Low
I:E LIMIT
The inspiratory: expiratory ratio for a mandatory breath
exceeds 4:1. The inspiratory phase of the breath is
terminated.
Not active in APRV / BIPHASIC
mode.
Low
LOW FiO2
Delivered oxygen percentage falls below the set FiO2 minus
6% or 18% FiO2., whichever is greater.
N/A
High
HIGH FiO2
Delivered oxygen percentage rises above the set FiO2 plus 6%
N/A
High
CIRCUIT
DISCONNECT
A high priority audible/visual alarm is activated, and CIRCUIT
DISCONNECT displayed, whenever the patient circuit
becomes disconnected from the ventilator or patient.
N/A
High
LOW BATTERY
A high priority audible/visual alarm is activated, and LOW
BATTERY displayed, whenever the internal battery has been
depleted to a level that provides a minimum of two minutes of
safe operation.
N/A
High
LOSS, AC
A high priority audible/visual alarm is, and LOSS, AC
N/A
High
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Operator’s Manual
Message
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6-13
Chapter 6 Alarms and Indicators
Alarm Condition
Range
Priority
POWER
POWER displayed, whenever the power switch is on and AC
power has been removed from the ventilator (i.e. power cord
disconnect or loss of supply power).
ILV
DISCONNECT
A high priority audible/visual alarm is activated, and ILV
DISCONNECT displayed, whenever the master ventilator
becomes disconnected from the slave ventilator during ILV.
N/A
High
INVALID GAS ID
A medium priority audible/visual alarm shall be activated, and
INVALID GAS I.D. shall be indicated whenever a defective gas
I.D. connector is installed in the ventilator. When a defective
Gas I.D. connector is detected, the gas corrections default to
air.
N/A
Medium
FAN FAILURE
A low priority audible/visual alarm is activated, and FAN
FAILURE indicated, whenever the fan has stopped rotating.
N/A
Low
6-14
Chapter 6 Alarms and Indicators
AVEA Ventilator Systems
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Operator’s Manual
Chapter 7 Maintenance and Cleaning
Cleaning & Sterilization
The AVEA is designed for easy maintenance. All exposed parts of the ventilator are corrosion resistant.
CAUTION
DO NOT submerge the ventilator or pour cleaning liquids over or into the ventilator.
To minimize cleaning and replacement frequency, the AVEA design places the exhalation manifold, flow sensor and
diaphragm behind the exhalation filter and water trap.
In the event that they do require cleaning, use the methods given below under “Cleaning of Accessories and Ventilator
Parts”.
Cleaning External Surfaces
All external surfaces of the ventilator can be wiped clean with one of the following:
Isopropyl Alcohol
Chlorine Compounds*
Maximum Concentration: 1:10
*These compounds are diluted by volume in water
Cleaning Accessories and Parts
1.
Using Alcohol or Chlorine compounds
The following accessory can be wiped clean using the Isopropyl Alcohol or Chlorine Compounds listed above:
The exhalation cartridge.
2.
Using an Enzyme Pre-Soaking Solution
The following accessory parts are cleanable using an enzyme pre-soaking solution such as Klenzyme®:
The water trap
The Infant Hot Wire flow sensor
The recommended method for cleaning these parts is as follows:
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1.
Prepare an enzyme based pre-soaking solution (Klenzyme® made by Steris Corporation, Mentor, OH or
equivalent) in accordance with manufacturer’s instructions, using sterile distilled water at 20-30°C (6886°F).
2.
Immerse the part to be cleaned in the prepared solution for 10 minutes. Make sure that all lumens and air
pockets are completely filled with the solution. Agitate periodically to loosen any attached debris.
3.
Remove the part from the solution after 2-5 minutes and rinse immediately by immersing in at least 1
gallon of sterile distilled water at 20-30°C (68-86°F). Leave the part in the rinsing bath for at least 1 minute
agitating periodically to ensure thorough rinsing.
4.
Visually inspect the part after removing it from the rinse to ensure that no debris remains on the part.
Repeat the cleaning method if necessary.
7-2
Chapter 7 Maintenance and Cleaning
3.
AVEA Ventilator Systems
Steam Sterilization
These parts can also be steam sterilized (autoclave).
The water trap
The Infant Hot Wire flow sensor
Water collection jars.
Steam Sterilization (autoclave), maximum temperature 138°C (280°F), minimum temperature 132°C (270° F) for a
maximum of 18 minutes and a minimum of 15 minutes (maximum number of cycles 30).
Vacuum Steam Cycle:
3 pre-condition pulses (vacuum pulses). Sterilizer vacuum target set to 10-26 psig. Dwell at 132° - 138° deg C for 4 to 8
minutes duration. Minimum dry time: 15 minutes. 50 cycles maximum for the infant flow sensor and 25 cycles maximum
for the water trap/water collection jar.
Parts not made by VIASYS Respiratory Care (Bird)
The exhalation filter should be sterilized per the instructions supplied by the manufacturer, (Pall Medical) enclosed with
the filter.
Warning: Do not immerse the filter in liquid when cleaning.
The AVEA is designed to accept certain non-proprietary accessories. If you choose to use a different filter with your
ventilator, follow the manufacturer’s instructions to clean/sterilize the part.
Disposable Parts
The following are considered disposable parts and VIASYS Respiratory Care Inc. does not, therefore, recommend a
method of cleaning or sterilization.
Disposable variable orifice flow sensors
Tracheal adapters
Tracheal catheters
Esophageal catheters
Other Accessories
For all other accessories purchased for use with your AVEA but not supplied by VIASYS Respiratory Care Inc., follow the
manufacturer’s recommendations for cleaning or sterilization.
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Chapter 7 Maintenance and Cleaning
7-3
Recommended Periodic Maintenance
VIASYS Respiratory Care Inc. is committed to product support. If you have any questions concerning your ventilator’s
operation or maintenance contact your product support representative as shown in Appendix A, Contact Information.
A Preventive Maintenance service should be performed on your AVEA ventilator once per year. Call VIASYS
Respiratory Care, Customer Care, at the number given in Appendix A to arrange for a qualified Service Technician to
perform this.
WARNING
Electric shock hazard - Do not remove any of the ventilator covers or panels. Refer all servicing to an
authorized VIASYS Respiratory Care service technician.
The annual maintenance will include the following.
Replacement of:
The Air inlet Filter
The Oxygen Inlet Filter
The Compressor Inlet Filter (on compressor equipped models)
The Compressor Outlet Filter (on compressor equipped models)
The Exhalation Diaphragm.
At this time the following maintenance will be performed:
Removal & replacement of the above items
Verification that the following transducers are within calibration specifications:
Air
O2
Blended Gas
Expiratory
Inspiratory
Exhaled Flow delta
Wye flow delta
Auxiliary
Esophageal
•
Testing of the compressor output (on compressor equipped models)
•
Verification Testing to confirm the ventilator is functioning within optimum parameters.
•
Screen Calibration
AVEA Maintenance should only be performed by a trained and authorized service technician. VIASYS Respiratory Care
will make available to qualified technicians, service manuals, which include such items as circuit diagrams, component
parts lists, calibration instructions and other information to assist in repair of those parts of the ventilator designated by
the manufacturer as repairable items.
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7-4
Chapter 7 Maintenance and Cleaning
AVEA Ventilator Systems
WARNING
If a mechanical or electrical problem is recognized while operating the ventilator, the ventilator must be
removed from use and referred to qualified personnel for servicing.
Using an inoperative ventilator may result in patient injury.
Battery Care
The AVEA has an internal, Nickel Metal Hydride battery pack that will provide power
backup for short periods in the event that the mains power supply is lost (see figure 6.1).
Under normal operating conditions and when fully charged, the internal battery is capable
of powering the ventilator alone for 1 hour or the ventilator and compressor for 30
minutes.
Figure 6.1 Internal Battery Pack
NOTE
The internal battery is intended only for short duration backup in the event of disruptions in line power. The internal
battery provides 30 minutes of battery power for the ventilator and compressor nominally. The recharging cycle for this
battery can be up to 4 hours depending on the state of discharge. Should you wish to perform intra-facility transport of
patients you should equip your instruments with the optional external battery. The addition of the external battery will
extend the time period to 2 hours for ventilator and compressor.
VIASYS Critical Care recommends that when used in transport situations the expected transport time should not be
greater than 50% of the usable battery life. This provides a safety margin in the event of schedule delays or premature
consumption of the battery power. Should the expected transport time be delayed beyond this, a dedicated transport
system should be considered. As with any patient transport, suitable manual ventilation backup should be available.
CAUTION
The ventilator should be connected to a mains AC power supply for at least 4 hours prior to switching to internal battery
power. For operation on external battery the ventilator should be connected to a mains AC power supply for at least 12
hours to insure a fully charged battery.
An optional sealed lead-acid external battery pack is also available. This can significantly extend the operating period of
the ventilator when it is not connected to an AC source. Under normal operating conditions, fully charged external and
internal batteries combined are capable of powering the ventilator and compressor for a period equal to or greater than 2
hours, and the ventilator on wall air for a period equal to or greater than 4 hours.
Both battery types are re-chargeable and require minimal maintenance when installed. Do not allow your battery to
become completely discharged as this may damage the ventilator. To ensure that the batteries remain charged and to
prolong their life, we recommend that you keep the ventilator plugged in to the AC power supply when not in use. The
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Chapter 7 Maintenance and Cleaning
7-5
Battery Status Indicators on the front panel will enable you to monitor the available charge remaining in your battery.
(See chapter 5, Alarms & Indicators).
CAUTION
Should your internal battery require replacement, contact your VIASYS Respiratory Care representative. Do NOT
attempt to replace the battery yourself. The battery should only be replaced by a qualified technician.
Precedence of power use
The sequence in which the power sources are used by the ventilator is:
1. AC
2. External Battery (if installed)
3. Internal Battery
CAUTION
Do not store the ventilator in hot areas for prolonged periods of time. Temperatures above 80°F (27 °C) can shorten
battery life. Failing to charge the ventilator while in storage may also shorten battery life.
CAUTION
When the integrity of the external power earth conductor arrangement is in doubt, operate the ventilator from its internal
battery or the optional external battery.
Battery Status
Battery status indicators showing the state of charge of each of the internal and external batteries appear on the front
panel of the ventilator. These appear as shown in figure 5.1.
If the battery charge is allowed to drop below the low range of the battery monitor, a battery status indicator LED may no
longer be displayed. The unit should be plugged into the AC power supply to allow the batteries to re-charge. When the
battery voltage becomes large enough to power the battery monitor, the battery status indicators will display.
CAUTION
A battery that is fully drained (i.e. void of any charge) may cause damage to the ventilator and should be replaced.
Contact your VIASYS Respiratory Care, Customer Care, representative at the number given in Appendix A Contact
information.
Failure to charge
If the internal batteries do not show significant re-charge after being re-connected to an AC power source for 4 hours
contact your VIASYS Respiratory Care, Customer Care, representative as shown in Appendix A to arrange for
replacement. Total time to re-charge will depend upon the extent of battery depletion and ventilator usage while
charging is taking place.
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7-6
Chapter 7 Maintenance and Cleaning
AVEA Ventilator Systems
Note
A ventilator not in use and not connected to AC, will continue to slowly discharge. A fully charged battery may reach a
deep discharge state (below 11 VDC) in approximately 35 days for the internal battery and 100 days for the external
battery. However, even with a fully charged battery, if the ventilator is unplugged from AC for more than 4 hours, the
internal battery status indicator will display red indicating a low battery condition. In this condition the ventilator should be
plugged into an AC outlet for 10-12 minutes to restore the battery to the correct charge state.
Fuses
The AVEA has the following replaceable fuses associated with internal DC, external DC and AC power sources.
WARNING
Do not remove or replace fuses or perform any maintenance tasks on the ventilator while your patient is
connected. Always perform these tasks “off patient”.
Battery Fuses
External
Battery Fuse
Holder
The internal and optional external battery fuses are
10A, 250V 5 x 20 mm fast blow type.
The fuse for the optional external battery is located on
the back panel next to the external battery connector
and is replaceable. The fuse for the internal battery is
located to the right of the UIM connection. To remove
fuses, carefully unscrew with a flat blade screwdriver
and pull out the fuse holder.
External
Battery
Connector
Figure 6.2 External Battery Connector & Fuse
WARNING
To avoid fire hazard, use only the fuse specified in the ventilator’s parts list or one that is identical in type,
voltage rating, and current rating to the existing fuse.
Mains Fuses
The main AC power fuses are housed within the power entry module located on the back panel. They are slow blowtype. Check that the correct voltage for your mains supply is showing through the window in the power entry module.
Table 6.1 Mains fuses
Line Voltage
Fuse
Amperage
100/120VAC
250V 6.35 x 31.75mm
3.2A
230/240VAC
250v 6.35 x 31.75mm
1.5A
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Operator’s Manual
Chapter 7 Maintenance and Cleaning
7-7
Replacing a Mains Electrical Fuse
WARNING
Ensure that the mains power cord is unplugged before attempting to remove or replaces fuses.
To replace mains electrical fuses, refer to figures 6.3 through 6.7 and do the following:
L2786
1.
Unplug the ventilator from the mains AC power source and unplug the power cord from the power entry
module on the rear of the ventilator.
2.
Using a small flat blade screwdriver, pry open the cover of the power entry module.
3.
Carefully ease the red fuse holder out of the power entry module.
4.
The fuse holder contains two identical fuses, either 3.1Amp for (for 100/120 volt lines) or 2.0 Amp (for
230/240 volt lines) as shown in table 6.1.
5.
Replace the failed fuse in the fuse holder with a fuse whose type, voltage rating, and current rating is
identical to the fuses supplied from the factory.
6.
Carefully replace the red fuse holder into the power entry module. Check to ensure that the correct line
voltage is uppermost as you re-insert the fuse holder into the power entry module.
7.
Close the power entry module cover and check to make sure that the correct voltage is displayed through
the window.
7-8
Chapter 7 Maintenance and Cleaning
AVEA Ventilator Systems
Changing the AC Fuses:
Figure 6.3
Opening the
power
entry module
with a
screwdriver
Figure 6.4
Removing the
fuse holder
Figure 6.5
Fuse holder
showing fuse
placement
Figure 6.6
Fuse-holder
with 230V
label uppermost
for 230/240VAC
systems.
Figure 6.7
closed power
entry module
with 115V
showing in the
window for
100/120 volt
systems
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Operator’s Manual
Appendix A Contact & Ordering Information
How to Call for Service
To get help on performing any of the preventive maintenance routines, or to request service on your ventilator, contact
VIASYS Respiratory Care Customer Care:
Technical and Clinical Support
Hours: 6:30 AM to 4:30 PM (PST) Monday through Friday
Phone: (800) 231-2466
Fax:
(714) 283-8471
After hours service:
Phone: (800) 231-2466 from within the US and select option 2.
VIASYS Respiratory Care Customer Care Helpline
Hours:
24 hours, seven days a week
Phone:
(800) 231-2466 from within the US
Online service for warranty replacements parts can be found at
www.viasyshealthcare.com/bird
Select “Warranty Form” from the choices on the left of the screen.
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A-2
Appendix A Contact & Ordering Information
AVEA Ventilator Systems
Ordering Parts
To obtain AVEA Ventilator parts, contact VIASYS Respiratory Care customer service at:
Hours:
7:00 Am to 4:30 PM (PST)
Monday through Friday
Phone:
(800) 328-4139
(760) 778-7200
Fax:
(760) 778-7274
Accessories
Neonatal Kit Part Number 50-40012-00
VIASYS Part Number
50000-40038
Description
Neonatal disposable flow sensor
Quantity
1
External Battery Option
To add the external battery option to your AVEA, you will need to order the following parts:
VIASYS Part Number
Description
Quantity
33977
External Battery Tray Assembly
1
16217
External Battery Wire Harness
1
68269
AVEA External Battery
2
Other Replacement Parts and Accessories
VIASYS Part Number
71667
Description
Internal/External Battery Fuse
71612
100/120 VAC Mains Power Supply Fuse
56000-20064
230/240 VAC Mains Power Supply Fuse
33978
51000-40640
Gas Tank Rack Assembly
Filter Cartridge
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B-1
Operator’s Manual
Appendix B Specifications
Pneumatic Supply
Air or Heliox Supply
Pressure Range:
20 to 80 psig (1.4 to 5.5 bar)
(Supply Air)
20 to 80 psig (1.4 to 5.5 bar)
(Supply Heliox – 80% / 20% Heliox only)
3 to 10 psig (0.2 to 0.7 bar)
(Compressor Air)
Temperature:
5 to 40º C (41 to 104º F)
Humidity:
Dew Point of gas should be 1.7º C (3º F) below the ambient temperature (minimum)
Minimum Flow:
80 L/min at 20 psig (1.4 bar)
Air Inlet Fitting:
CGA DISS-type body, No. 1160. NIST fitting per BS-5682:1984 (Air) also available.
Heliox Inlet Fitting: CGA DISS-type body, No. 1180. NIST fitting per BS-5682:1984 (Heliox) also available.
Oxygen Supply
Pressure Range:
20 to 80 psig (1.4 to 5.5 bar)
(Supply Oxygen)
Temperature:
5 to 40º C (41 to 104º F)
Humidity:
Dew Point of gas should be 1.7º C (3º F) below the ambient temperature (minimum)
Minimum Flow:
80 L/min at 20 psig (1.4 bar)
Inlet Fitting:
CGA DISS-type body, No. 1240. NIST fitting per BS-5682:1984 (O2) also available.
Electrical Supply
AC Power Supply
The ventilator operates within specification when connected to the following AC power supplies:
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Nominal
Voltage Range
Frequency Range
100 VAC
(85 to 110 VAC)
47 to 65 Hz
120 VAC
(102 to 132 VAC)
55 to 65 Hz
230 VAC
(196 TO 253 VAC)
47 to 65 Hz
240 VAC
(204 TO 264 VAC)
47 to 65 Hz
B-2
Appendix B Specifications
AVEA Ventilator Systems
DC Power Supply
The ventilator can also operate from a 24 VDC power source (internal or external battery).
Internal Battery:
Maximum charge time to achieve a full charge is 4 hours. Under normal operating conditions, the internal battery is
capable of powering the ventilator alone for 1 hour and powering the ventilator and compressor for 30 minutes when fully
charged. The ventilator should be connected to a main A/C supply and charged for at least 4 hours prior to switching to
battery power.
External Battery: 22.0 to 26.4 VDC
Under normal operating conditions, fully charged external and internal batteries combined are capable of powering the
ventilator and compressor for a period of time equal to or greater than 2 hours and the ventilator alone for a period of
time equal to or greater than 7 hours. With a discharged battery the ventilator should be connected to a main AC supply
and charged for at least 12 hours to insure a full charge.
Data Input / Output
Independent Lung Ventilation (ILV)
The ventilator provides an output (master) and an input (slave) for synchronization of ventilators. The output supplies a
5 VDC logic signal synchronized to the breath phase of the master via a 25-pin connector on the rear of the ventilator.
The pin configuration for this connector is as follows:
PIN
FUNCTION
1
Analog Input Channel 0
14
Analog Input Channel 1
18
ILV In
6
ILV Out
20
Factory Use Only, DO NOT CONNECT
22
Analog Output, PRESSURE
23
Analog Output, FLOW
24
Analog Output, VOLUME
25
Analog Output, BREATH PHASE
5,9,10,11,12,13
Ground, Analog
Note
At least one analog ground is required for safe and accurate signal output and input.. One analog ground is sufficient for
any and all of the other signals.
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Appendix B Specifications
B-3
Analog Inputs
The ventilator provides 2 programmable channels for analog signal inputs as shown above. Each channel is scalable for
the input ranges specified.
Ranges:
0 to 1 VDC
0 to 5 VDC
0 to 10 VDC
Resolution:
0.25 mV (for 0 to 1 VDC)
1.37 mV (for 0 to 5 VDC)
2.5 mV (for 0 to 10 VDC)
Analog Outputs
The ventilator provides 4 signals to the analog output connector:
1.
2.
Airway Pressure, PAW:
Range:
-60 to 140 cmH2O
Scale:
1 cmH2O/25 mV
Accuracy:
± 50 mV or ± 5% of reading, whichever is greater
Zero Offset:
1.5 VDC at 0 cmH2O
Flow
Inspiratory/Expiratory:
When selected, the ventilator provides a continuous analog voltage representative of inspiratory flow minus
expiratory flow.
Range:
-300 to 200 L/min (Adult)
-120 to 80 L/min (Pediatric)
-60 to 40 L/min
Scale Factor:
(Neonate)
1 L/min / 10 mV (Adult)
1 L/min / 25 mV (Pediatric)
1 L/min / 50 mV (Neonate)
Accuracy:
Zero Offset:
± 10% of reading or ± 30 mV, whichever is greater
3.0 VDC at 0 L/min
Machine:
When selected, the ventilator provides a continuous analog voltage representative of machine delivered flow.
Range:
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0 to 200 L/min
(Adult)
0 to 100 L/min
(Pediatric)
0 to 50 L/min
(Neonate)
B-4
Appendix B Specifications
Scale Factor:
AVEA Ventilator Systems
1 L/min / 25 mV (Adult)
1 L/min / 50 mV (Pediatric)
1 L/min / 100 mV (Neonate)
3.
Accuracy:
± 10% of reading or ± 30 mV, whichever is greater
Zero Offset:
None
Volume:
Range:
Scale Factor:
4.
-1.00 to 4.00 L
(Adult)
-200 to 800 ml
(Pediatric)
-100 to 400 ml
(Neonate)
1L/V
(Adult)
1 ml / 5 mV
(Pediatric)
1 ml / 10 mV
(Neonate)
Accuracy:
± 10% of reading or ± 30 mV, whichever is greater
Zero Offset:
1.000 VDC
Breath Phase
The ventilator provides a continuous analog voltage representative of breath phase (Inspiration = 5 VDC, Expiration
= 0 VDC).
Digital Communication
The ventilator has two RS-232 ports installed for bi-directional communication of data: RS-232 Ch1 is currently used for
software updates as well as data communications to external systems. The communications protocol is available from
VIASYS Respiratory Care, P/N L2317. RS-232 Ch2 is currently undefined.
Printer
The ventilator has a standard 25-pin female Centronics parallel printer port for interfacing to an external printer.
Remote Nurse Call
The ventilator has a modular jack configured to interface with external systems that are either wired for normally open
(N.O., close on alarm) or normally closed (N.C., open on alarm) signals.
In the active state, the remote alarm can sink 1.0 A.
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Operator’s Manual
Appendix B Specifications
B-5
Video Output
The ventilator provides a video output connector, which allows for interfacing to an externally located 256-color, 800 x
600, SVGA monitor.
Atmospheric & Environmental Specifications
Temperature and Humidity
Storage
Temperature:
−20 to 60º C (−4 to 140º F)
Humidity:
Operating
0 to 95% RH non-condensing
Temperature:
5 to 40º C (41 to 104º F)
Humidity:
0 to 95% RH non-condensing
Barometric Pressure
760 to 545 mmHg
Physical Dimensions
Overall Size
Ventilator
17” W x 16” D x 10.5” H or (43.2 cm X 40.6 cm X 26.7 cm)
UIM
16.25” W x 2.5” D x 13.75” H (41.3 cm X 6.4 cm X 34.9 cm)
Weight
Ventilator w/ UIM no compressor
< 73 lbs. (33.1 kg)
Ventilator w/UIM and Compressor < 80 lbs (36.3 kg)
L2786
B-6
Appendix B Specifications
AVEA Ventilator Systems
Accessories
Pall Microbial Filter
Resistance
The exhalation filter supplied with your AVEA ventilator is manufactured by Pall Medical of Ann Arbor, MI, USA. The
published maximum resistance of this filter is 4cmH2O at 100 L/min for the 725 filter.
Compliance
The compliance for the filter is < 0.4 ml/cmH2O.
Materials
Materials used in the construction of the filter have passed USP Class VI 121° C Plastic and Cytotoxicity test.
For further information please contact Pall Medical.
Water Trap
Resistance
The resistance of the internal exhalation water trap assembly including the collection bottle is < 0.5 cmH2O at 50 L/min.
Compliance
The compliance of the internal exhalation water trap assembly including the collection bottle is < 0.2 ml/cmH2O.
L2786
C-1
Operator’s Manual
Appendix C Pneumatic Diagram
Gas Delivery Engine
The Gas Delivery Engine receives and conditions supplied Oxygen and Air from external and/or internal (compressor) sources. It
then mixes the gas to the concentration required and delivers the desired flow, or pressure to the patient.
The Gas Delivery Engine begins with the Inlet Pneumatics. The Inlet Pneumatics accepts clean O2, or Air; it provides extra
filtration and regulates air and O2 gas before entering the Oxygen Blender. The Oxygen Blender mixes the gases to the desired
concentration before reaching the Flow Control Valve. The Flow Control Valve controls the flow rate of the gas mixture to the
patient. Between the Oxygen Blender and Flow Control Valve, the Accumulator System is installed to provide peak flow capacity.
The Flow Sensor provides information about the actual inspiratory flow for closed loop servo control. The gas is then delivered to
the patient through the Safety/Relief Valve and Outlet Manifold.
Compressor
Flow
(Optional)
Air
Oxygen
Inlet
Pneumatics
Oxygen
Blender
Accumulator
System
Flow Control
Valve
Flow Sensor
Figure C1 Gas Delivery Engine
L2786
Safety/Relief
Valve &
Manifold
Patient
Flow
C-2
Appendix C Pneumatic Diagram
AVEA Ventilator Systems
This page intentionally left blank
L2786
D-1
Operator’s Manual
Appendix D Monitor Ranges and Accuracies
DISPLAY
DESCRIPTION
RANGE
ACCURACY
VOLUME MONITORS
The volume measured during the inspiratory phase of the breath is accumulated as the inspired tidal volume, and the volume
measured during the exhalation phase is accumulated as the exhaled tidal volume. This volume does not include the volume
delivered by the Circuit Compliance Compensation function for volume breaths.
Vte
Exhaled tidal volume.
0 to 4 L
Exhaled tidal volume adjusted for patient weight
0 to 4 ml/kg
Inspired tidal volume.
0 to 4 L
Inspired tidal volume adjusted for patient weight
0 to 4 ml/kg
Spontaneous tidal volume.
0 to 4 L
Spon Vt/kg
Spontaneous tidal volume adjusted for patient
weight
0 to 4 ml/kg
Mand Vt
Mandatory tidal volume. Displayed as a rolling
average of either 8 breaths or one minute,
whichever occurs first.
0 to 4 L
(± 20ml + 10% of reading)-Adult machine
sensor
(± 1 ml + 10% of reading)-Neonate wye
sensor
Mandatory tidal volume adjusted for patient weight
0 to 4 ml/kg
Derived
Delivered machine volume measured by the
ventilator’s inspiratory flow sensor.
0 to 4L
(± 20ml + 10% of reading)-
Percent leakage. The difference between the
inspired and exhaled tidal volumes in terms of %
difference.
Derived
Derived
Minute Volume. Volume of gas exhaled by the
patient during the last minute.
0 to 99.9 L
Derived
Minute volume adjusted for patient weight
0 to 999 ml/kg
Derived
Spontaneous minute volume.
0 to 99.9L
Derived
Spontaneous minute volume adjusted for patient
weight
0 to 999ml/kg
Derived
0 to 200 bpm
± 3% or ± 2 bpm whichever is greater
Vte/kg
Vti
Vti/kg
Spon Vt
Mand Vt/kg
Vdel
% Leak
Ve
Ve/kg
Spon Ve
Spon Ve/kg
(± 20ml + 10% of reading)-Adult machine
sensor
(± 1 ml + 10% of reading)-Neonate wye
sensor
(± 20ml + 10% of reading)-Adult machine
sensor
(± 1 ml + 10% of reading)-Neonate wye
sensor
(± 20ml + 10% of reading)-Adult machine
sensor
(± 1 ml + 10% of reading)-Neonate wye
sensor
RATE/TIME MONITORS
Rate
Spon Rate
L2786
Breath Rate.
Spontaneous breath rate.
0 to 200 bpm
± 3% or ± 2 bpm whichever is greater
Ti
Inspiratory time.
0.00 to 99.99
sec
± 0.03 sec
Te
Exhalation Time.
0.00 to 99.99
sec
± 0.03 sec
I:E
Inspiratory/expiratory ratio
Note: Not active for demand breaths.
1:99.9 to
99.9:1
Derived from accuracies for monitored Ti
and Te
D-2
Appendix D Monitor Ranges and Accuracies
Display
f/Vt
AVEA Ventilator Systems
Description
Range
Accuracy
Rapid shallow breathing index.
0 to 500
b2/min/L
Derived from accuracies for spontaneous
breath rate and spontaneous minute
volume
PRESSURE MONITORS
Ppeak
Peak inspiratory pressure.
Not active with spontaneous breaths
0 to 120
cmH2O
± 3.5% of reading or ± 2 cmH2O,
whichever is greater
Pmean
Mean airway pressure.
0 to 120
cmH2O
± 3.5% of reading or ± 2 cmH2O,
whichever is greater
Pplat
Plateau pressure. If no plateau occurs, then the
monitor displays * * *
0 to 120
cmH2O
± 3.5% of reading or ± 2 cmH2O,
whichever is greater
PEEP
Positive end expiratory pressure.
0 to 60 cmH2O
± 3.5% of reading or ± 2 cmH2O,
whichever is greater
Air Inlet
Air inlet gas supply pressure.
0 to 80 psig
± 5 psig (1.4 – 5.5 bar)
O2 Inlet
Oxygen inlet gas supply pressure.
0 to 80 psig
± 5 psig (1.4 - 5.5 bar)
0 to 100%
± 3%
0 to 300
ml/cmH2O
Derived
GAS COMPOSITION MONITORS
FiO2
Delivered percent O2.
MECHANICS
Cdyn
Dynamic Compliance (CDYN and CDYN / Kg),
absolute and normalized to patient weight.
Cdyn/Kg
Cstat
0.00 to 5.00
ml/cmH2O⋅kg
Respiratory System Compliance (CRS), (a.k.a.
Static Compliance CSTAT), absolute and normalized
to patient weight.
Note: This requires an Inspiratory Hold maneuver.
0 to 300
ml/cmH2O
Rrs
Respiratory system resistance.
Note: Calculation is performed during an Inspiratory
Hold maneuver.
0 to 100
cmH2O/L/sec
Derived
PIFR
Peak Inspiratory flow rate.
0 to 300 L/min
(All patients)
± 10% of setting or ± (0.2 L/min + 10%
of setting), whichever is greater
PEFR
Peak Expiratory flow rate.
0 to 300 L/min
(All patients)
± 10% of setting or ± (0.2 L/min + 10%
of setting), whichever is greater
Ccw
The ratio of the tidal volume (exhaled) to the Delta
Esophageal Pressure (dPES). Requires an
esophageal balloon.
0 to 300
mL/cmH2O
+ 10%
CLUNG
The ratio of the tidal volume (exhaled) to the delta
transpulmonary pressure. The delta
transpulmonary pressure is the difference between
the airway plateau pressure (during an inspiratory
pause) and esophageal pressure (at the time the
airway plateau pressure is measured) minus the
difference between the airway and esophageal
baseline pressures. Requires an inspiratory hold
and esophageal balloon.
0 to 300
mL/cmH2O
+ 10%
C20 / C
The ratio of the dynamic compliance during the last
20% of inspiration (C20) to the total dynamic
compliance (C).
0.00 to 5.00
+ 10%
Cstat/Kg
Derived
0.00 to 5.00
ml/cmH2O⋅kg
L2786
Operator’s Manual
Display
L2786
Appendix D Monitor Ranges and Accuracies
Description
Range
Accuracy
RRS
The total resistance during the inspiratory phase of
a breath. Respiratory System Resistance is the
ratio of the airway pressure differential (peak –
plateau) to the inspiratory flow 12 ms prior to the
end of inspiration. Requires an inspiratory hold.
0 to 100
cmH2O/L/sec
+ 10%
RPEAK
The Peak Expiratory Resistance (RPEAK), is defined
as the resistance at the time of the Peak Expiratory
Flow (PEFR).
0.0 to 100.0
cmH2O/L/sec
+ 10%
RIMP
The airway resistance between the wye of the
patient circuit and the tracheal sensor. Requires an
inspiratory hold and tracheal catheter.
0.0 to 100.0
cmH2O/L/sec
+ 10%
RLUNG
The ratio of the tracheal pressure differential (peak
– plateau) to the inspiratory flow 12 ms prior to the
end of inspiration. Requires an inspiratory hold and
tracheal catheter.
0.0 to 100.0
cmH2O/L/sec
+ 10%
dPAW
The difference between peak airway pressure
(PPEAK AW) and baseline airway pressure (PEEPAW).
−120 to 120
cmH2O
+ 2 cm H2O or + 5% whichever is greater
dPES
The difference between peak esophageal pressure
(PPEAK ES) and baseline esophageal pressure
(PEEPES).
−120 to 120
cmH2O
+ 2 cm H2O or + 5% whichever is greater
AutoPEEP
The airway pressure at the end of an expiratory
hold maneuver. Requires a passive patient.
0 to 50 cmH2O
+ 2 cm H2O or + 5% whichever is greater
dAutoPEEP
The difference between airway pressure at the end
of an expiratory hold maneuver and the airway
pressure at the start of the next scheduled breath
after the expiratory hold maneuver. Requires a
passive patient.
0 to 50 cmH2O
+ 2 cm H2O or + 5% whichever is greater
AutoPEEPES
The difference between esophageal pressure
measured at the end of exhalation (PEEPES) minus
the esophageal pressure measured at the start of a
patient-initiated breath (PES start) and the sensitivity
of the ventilator’s demand system. The sensitivity
of the ventilator’s demand system is the difference
between the baseline airway pressure (PEEPAW)
and the airway pressure when the patient initiates a
breath (PAW start). Requires an esophageal balloon.
0 to 50 cmH2O
+ 2 cm H2O or + 5% whichever is greater
Ptp Plat
Transpulmonary pressure during an inspiratory
hold, which is the difference between the airway
plateau pressure (PPLAT AW) and the corresponding
esophageal pressure. Requires an inspiratory hold
and esophageal balloon.
−60 to 120
cmH2O
+ 2 cm H2O or + 5% whichever is greater
Ptp PEEP
The difference between the corresponding airway
and esophageal pressures at the end of the
expiratory hold during an AutoPEEP maneuver.
Requires an inspiratory hold and esophageal
catheter.
−60 to 120
cmH2O
± 2 cmH2O or ± 5%, whichever is greater
MIP
The maximum negative airway pressure that is
achieved by the patient, during an expiratory hold
maneuver.
−60 to 120
cmH2O
± 2 cmH2O or ± 5%, whichever is greater
P100
The negative pressure that occurs 100 ms after an
inspiratory effort has been detected.
−60 to 120
cmH2O
± 2 cmH2O or ± 5%, whichever is greater
D-3
D-4
Appendix D Monitor Ranges and Accuracies
Display
Description
Range
Accuracy
WOBV
The summation of airway pressure (PAW) minus the
baseline airway pressure (PEEPAW) times the
change in tidal volume to the patient (ΔV) during
inspiration, and normalized to the total inspiratory
tidal volume (Vti).
0.00 to 20.00
Joules/L
+ 10%
WOBP
Patient Work of Breathing (WOBP), normalized to
the total inspiratory tidal volume. Patient work of
breathing is defined as the summation of two work
components: work of the lung and work of the chest
wall. Requires an esophageal balloon.
0.00 to 20.00
Joules/L
+ 10%
WOBI
The work performed by the patient to breathe
spontaneously through the breathing apparatus, i.e.
the E.T. tube, the breathing circuit, and the demand
flow system. Requires a tracheal catheter.
0.00 to 20.00
Joules/L
+ 10%
AVEA Ventilator Systems
Note
Monitored values are displayed as BTPS
L2786
E-1
Operator’s Manual
Appendix E Sensor Specifications & Circuit Resistance
VarFlex® Sensor Specifications
Table E.1 Varflex Flow Sensor Specifications
Sensor
Infant 15 mm
Adult 15 mm
Part Number
Type
Circuit Location
Performance Specifications
Flow Range
Diff Pres Range
Accuracy*
Resistance
Dead Space
Freq. Response**
Airway Pres Range
Calibration (EEPROM)
Linearity
Operating Temperature
7002500
Single Use
Wye
7002300
Single Use
Wye
0.024 to 30 L/min
± 5.72 cmH2O
± (0.012 L/min + 5% or reading
4.5 cmH2O @ 30 L/min
0.7 ml installed
17 Hz
-140 to 140 cmH2O
29 Point Curve
< 1% between points
5° to 40° C
41° to 104° F
1.2 to 180 L/min
± 5.72 cmH2O
± (0.1 L/min + 5% or reading
2.4 cmH2O @ 60 L/min
9.6 ml installed
26 Hz
-140 to 140 cmH2O
29 Point Curve
< 1% between points
5° to 40° C
41° to 104° F
1.36 in (3.5 cm)
15 mm OD
15 mm OD
48 in (121.9 cm)
Bicore Proprietary
22 g (0.7 oz)
Single Patient Use
NA
Sensor – Lexan
Flap – Mylar
Tubing – PVC
Connector - ABS
2.45 in (6.2 cm)
15 mm OD
15 mm OD
73 in (185.4 cm)
Bicore Proprietary
31 g (1.0 oz)
Single Patient Use
NA
Sensor – Lexan
Flap – Mylar
Tubing – PVC
Connector - ABS
Physical Specifications
Sensor Length
Diameter Insp (Vent Side)
Diameter Exp (Patient)
Tube Length
Connector
Weight
Service Life
Sterilization
Material
L/min: Dry air at 77° F (25° C) and 14.7 psig barometric pressure.
* Includes ± 1% for linearity and hysteresis with no zero drift for the pressure transducer and ± 2 % for temperature and
humidity variations.
The sensor must be corrected for barometric pressure, and oxygen concentration.
** Frequency Response is signal attenuation to 0.707 input and assumes 100 Hz sample rate.
L2786
E-2
Appendix E Sensor Specifications & Circuit Resistance
AVEA Ventilator Systems
Hot Wire Flow Sensor Specifications
Table E-2 Hot wire sensor specifications
Part Number
Type:
Circuit Location:
Performance Specifications
Flow Range:
Vol. Accuracy:
Flow Resistance:
Dead Space:
Freq. Response*:
Calibration:
Linearity:
Operating Temperature:
Physical Specifications
Sensor length
Diameter Insp (Vent Side)
Diameter Exp (Patient Side)
Tube length
Connector
Weight
Service Life
Sterilization
Materials
51000-40081
Multiple use heated wire
Wye
0 (+/- 0.002) to 30 L/min
+/-10%
15 cmH2O @ 20 L/min
0.8 mL
16 Hz
36 point curve
< 2%
5 to 40oC
1.68”
15 mm OD
15 mm OD
N/A
Pin & Socket type
< 10g (not including wire)
25 cycles
Steam Autoclave
Sensor - Delrin
Wire – Platinum
Screen – Stainless Steel 304 or 316
Pin – PhBz, gold over nickel plated
Spacer - Delrin
Circuit Resistance (per EN794 –1)
It is important to check the inspiratory and expiratory resistance specification of patient circuits used with the AVEA to
ensure they do not exceed the following limits when adding attachments or other components or subassemblies to the
breathing circuit.
NOTE
Refer to product labeling supplied with any accessory to be added to the breathing circuit for this information.
0.6 KPA (6cmH2O) at 60 L/min for adult patients
0.6 KPA (6cmH2O) at 30 L/min for pediatric patients
0.6 KPA (6cmH2O) at 5 L/min for neonatal patients
L2786
Operator’s Manual
Appendix E Sensor Specifications & Circuit Resistance
E-3
WARNING
Total resistance of the inspiratory and expiratory limbs of the breathing circuit with accessories should
not exceed 4cmH2O at 5 L/min if inspiratory flows > 15 liters per minute are used in TCPL ventilation
modes.
Circuit Resistance Test
To measure the resistance of the inspiratory and expiratory limbs of the breathing circuit with accessories connect the
patient breathing circuit as described in Chapter 2.
1. Select TCPL SIMV with settings:
Rate
1
Inspiratory Pressure
15 cmH2O
Peak Flow
8.0 L/min
Inspiratory Time
0.35 sec
PEEP
0 cmH2O
Flow Trigger
20 Lmin
% O2
21 %
Bias Flow
5 L/min
Pressure trigger
20 cmH2O
2. Select waveform Pinsp
3. With the patient wye blocked, allow the baseline pressure (PEEP) to stabilize for 10 seconds
and press the FREEZE key.
4. Use the data dial to read the pressure from the Pinsp waveform. The pressure must not
exceed 4cmH2O at 5 L/min if inspiratory flows > 15 liters per minute are used in TCPL
ventilation modes.
L2786
E-4
Appendix E Sensor Specifications & Circuit Resistance
AVEA Ventilator Systems
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L2786
F-1
Operator’s Manual
Appendix F AVEA Message Bar Text
AVEA MESSAGE BAR TEXT
"Confirm Apnea Settings."
"Proximal Flow Sensor required."
"Bias Flow insufficient to allow Flow Trigger."
"Heliox concentration will change."
"Nebulizer not available."
"Confirm inspiratory pressure settings."
"Settings restored to defaults."
"Compliance Compensation not active for
NEO."
"Minimum 0.2 sec Inspiratory Time."
"Maximum 4:1 I:E Ratio."
"Maximum 3 sec Inspiratory Time."
"Maximum 5 sec Inspiratory Time."
"Invalid Calibration"
"Error saving Serial/Model Number"
Clear Messages
"FCV Characterization in progress."
"FCV Characterization complete."
"FCV Characterization failed."
Installed Software Version
Current Time, Date, and Runtime Hours
“DPRAM Comm. Error, Ctrl"
"Printing."
"Printer Out of Paper."
"Printer Offline."
"Printer Error."
"Printer Ready."
L2786
CAUSE
Selection of CPAP/PSV or APRV on Mode Select popup when
active.
Acceptance of Volume Limit setting when
Size is NEO, Volume Limit is active, and no Wye Flow Sensor
connected (Varflex or Hotwire).
Acceptance of Bias Flow setting or Flow Trigger setting when Flow
Trigger < (Bias Flow + 0.5 lpm).
Acceptance of %O2 setting when Heliox is being used.
Acceptance of Peak Flow setting < 15 lpm when Nebulizer is
active or on pressing of Nebulizer membrane key when Peak Flow
setting < 15 lpm
Selection of Volume Limit control when Volume Limit active (i. e.,
not at default / highest value for patient size).
Patient Accept when New Patient selected.
Size Accept when Size is NEO, and Circ Comp setting is nonzero.
Acceptance of any combination of settings that will produce an ITime of less than 0.2 seconds.
Acceptance of any combination of settings that will produce an I:E
Ratio of 4:1 or greater.
Acceptance of any combination of settings when size is NEO that
will produce an I-Time of greater than 3 seconds.
Acceptance of any combination of settings when size is PED or
ADULT that will produce an I-Time of greater than 5 seconds.
Service State Only:
Validation failure, while calibration dialog box is active for selected
device.
Service State Only:
On accept of Serial Number or Model Number Change.
Service State Only:
Validation success, while calibration dialog box is active for
selected device.
Service State Only:
On start of Flow Control Valve characterization procedure.
Service State Only:
On successful completion of Flow Control Valve characterization
procedure.
Service State Only:
Unsuccessful completion of Flow Control Valve characterization
procedure. Validation failure characterization and tuning data.
Power Up
Main key pressed.
Loss of Communication with Control microprocessor
Print Screen button was pressed; commenced sending screen
data to printer.
Print Screen button was pressed, printer reported it is out of
paper.
Print Screen button was pressed; printer is not available.
Print Screen button was pressed; printer reported an error
condition.
Sending screen data to printer has completed.
F-2
Appendix F AVEA Message Bar Text
AVEA MESSAGE BAR TEXT
"Printer Busy."
"Volume Limit disabled."
"Proximal Flow Sensor disconnected."
"Flow sensor is not Heliox-compatible."
"Proximal Airway Line disconnected."
"Proximal Flow Sensor conflict.
"Esophageal monitoring not available."
"Tracheal monitoring not available."
"Flow Sensor Error."
"Wye Sensor Error."
"Device Error."
"Esophageal Balloon Leak Test Failed."
“Stopped: Patient Effort Detected”
AVEA Ventilator Systems
CAUSE
Print Screen button was pressed, device has not completed
sending data from previous activation.
On disconnect of WFS (Neo or Hotwire) when Size is NEO and
Volume Limit is active.
On disconnect of WFS, any type.
On connect of Hotwire WFS when Heliox is active.
On disconnect of Proximal Pressure connection.
On simultaneous connect of Hotwire and VarFlex WFS.
On connect of Esophageal Balloon when size is NEO.
On connect of Tracheal Catheter when size is NEO.
On power up, failure to validate any internal flow sensor.
On connect and failure to validate any proximal flow sensor.
On detection of a fault classified as “Device Error” (see Fault
Section)
On failure of Esophageal Balloon leak test.
Upon detecting Patient effort in maneuvers which require a
passive patient
“Proximal Flow Sensor Ready”
L2786
G-1
Operator’s Manual
Appendix G Adjusting Barometric Pressure for Altitude
The default setting for barometric pressure on AVEA is 760 mm Hg. For institutions at altitudes of 1000 feet or greater,
barometric pressure can be set by the operator.
Open the screens menu by pressing the screen indicator on the touch screen or the “SCREENS” membrane button
located to the left of the touch screen.
Select utility from the screens menu. Press the touch screen button for barometric pressure and use the data dial to
change the setting. Once you have reached the desired barometric pressure setting, press the “ACCEPT” membrane
button adjacent to the data dial.
To close the utilities screen and return to the main screen, press the screen indicator again and select MAIN from the
menu or press the membrane button to the left of the touch screen labeled “MAIN”.
Below is a chart of approximate Barometric Pressure at varying altitude:
Table G.1 Altitude to Barometric Pressure Conversion2
Altitude
(ft)
2
Barometric
Pressure
(mm Hg)
0
760
1000
733
2000
707
3000
681
4000
656
5000
632
6000
609
7000
588
8000
567
9000
545
CRC Handbook of Chemistry and Physics 61st Edition,1980-1981, CRC Press, Inc. Boca Raton, Florida
L2786
G-2
Appendix G Adjusting Barometric Pressure for Altitude
AVEA Ventilator Systems
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L2786
H-1
Operator’s Manual
Appendix H Advanced Pulmonary Mechanics Monitored
Parameters
Rapid Shallow Breathing Index (f / Vt)
The ventilator is capable of displaying the calculated value for Rapid Shallow Breathing Index (f / Vt),
which is the spontaneous breath rate per tidal volume, and is based on the following formula:
f / Vt = f 2 / Ve , where f = spontaneous breath rate (BPM) and
Ve = spontaneous minute ventilation in LPM
Range:
0 to 500 b2/min/L
Resolution:
1 b2/min/L
Chest wall Compliance (CCW)
Chest wall Compliance (CCW), is the ratio of the tidal volume (exhaled) to the Delta Esophageal Pressure
(dPES).
CCW =
Vte
dPES
Range:
0 to 300 mL/cmH2O
Resolution:
1 mL/cmH2O
Note:
Requires an esophageal balloon catheter.
Accuracy:
± 10%
Lung Compliance (CLUNG)
Lung Compliance (CLUNG), is the ratio of the tidal volume (exhaled) to the delta transpulmonary pressure.
The delta transpulmonary pressure is the difference between the airway plateau pressure (during an
inspiratory pause) and esophageal pressure (at the time the airway plateau pressure is measured) minus
the difference between the airway and esophageal baseline pressures.
CLUNG =
Vte
, where dPPLAT TP = (PPLAT AW − PES) − (PEEPAW − PEEPES)
dPPLAT TP
Range:
0 to 300 mL/cmH2O
Resolution:
1 mL/cmH2O
Note:
Requires an Inspiratory Hold maneuver and an esophageal balloon catheter.
Accuracy: ±10%
L2786
H-2
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
AVEA Ventilator Systems
Compliance Ratio (C20 / C)
Compliance Ratio (C20 / C), is the ratio of the dynamic compliance during the last 20% of inspiration (C20)
to the total dynamic compliance (C).
Range:
0.00 to 5.00
Resolution:
0.01
Accuracy: ± 10%
Respiratory System Resistance (RRS)
Respiratory System Resistance (RRS), is the total resistance during the inspiratory phase of a breath.
Respiratory System Resistance is the ratio of the airway pressure differential (peak – plateau) to the
inspiratory flow 12 ms prior to the end of inspiration.
Range:
0 to 100 cmH2O/L/sec
Resolution:
0.1 cmH2O/L/sec
Limitation:
Active for volume breaths only.
Note:
Requires an Inspiratory Hold maneuver.
Accuracy:
± 10%
Peak Expiratory Resistance (RPEAK)
The ventilator shall be capable of calculating and displaying the Peak Expiratory Resistance (RPEAK),
which is defined as the resistance at the time of the Peak Expiratory Flow (PEFR).
RPEAK =
PPEFR
PEFR
Range:
0.0 to 100.0 cmH2O/L/sec
Resolution:
0.1 cmH2O/L/sec
Accuracy: ± 10%
Imposed Resistance (RIMP)
Imposed Resistance (RIMP), is the airway resistance between the wye of the patient circuit and the
tracheal sensor.
Range:
0.0 to 100.0 cmH2O/L/sec
Resolution:
0.1 cmH2O/L/sec
L2786
Operator’s Manual
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
Note:
Requires an Inspiratory Hold maneuver and a tracheal catheter.
Accuracy:
± 10%
H-3
Lung Resistance (RLUNG)
Lung Resistance (RLUNG), is the ratio of the tracheal pressure differential (peak – plateau) to the
inspiratory flow 12 ms prior to the end of inspiration.
Range:
0.0 to 100.0 cmH2O/L/sec
Resolution:
0.1 cmH2O/L/sec
Note:
Requires an Inspiratory Hold maneuver and a tracheal catheter.
Accuracy:
± 10%
Peak Inspiratory Flow Rate (PIFR)
The ventilator is capable of monitoring and displaying the actual peak inspiratory flow rate for the
inspiratory phase of a breath.
Range:
0 to 300 LPM
(All patients)
Resolution:
1 LPM
0.1 LPM
(Adult/Pediatric)
(Neonate)
Accuracy:
± 10%
Peak Expiratory Flow Rate (PEFR)
The ventilator is capable of monitoring and displaying the actual peak expiratory flow rate for the
expiratory phase of a breath.
Range:
0 to 300 LPM
(All patients)
Resolution:
1 LPM
0.1 LPM
(Adult/Pediatric)
(Neonate)
Accuracy:
± 10%
Delta Airway Pressure (dPAW)
Delta Airway Pressure (dPAW), which is the difference between peak airway pressure (PPEAK
baseline airway pressure (PEEPAW).
dPAW = PPEAK AW − PEEPAW
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Range:
−120 to 120 cmH2O
Resolution:
1 cmH2O
AW)
and
H-4
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
Accuracy:
AVEA Ventilator Systems
± 2cmH20 or ± 5%, whichever is greater
Delta Esophageal Pressure (dPES)
Delta Esophageal Pressure (dPES), is the difference between peak esophageal pressure (PPEAK ES) and
baseline esophageal pressure (PEEPES).
dPES = PPEAK ES − PEEPES
Range:
−120 to 120 cmH2O
Resolution:
1 cmH2O
Accuracy:
± 2cmH20 or ± 5%, whichever is greater
AutoPEEPAW
AutoPEEPaw, is the airway pressure at the end of an expiratory hold maneuver.
Range:
0 to 50 cmH2O
Resolution:
1 cmH2O
Accuracy:
± 2cmH20 or ± 5%, whichever is greater
Note
Requires a passive patient.
Delta AutoPEEPAW (dAutoPEEPAW)
Delta AutoPEEPAW (dAutoPEEPAW), is the difference between airway pressure at the end of an
expiratory hold maneuver and the airway pressure at the start of the next scheduled breath after the
expiratory hold maneuver.
Range:
0 to 50 cmH2O
Resolution:
1 cmH2O
Note:
Requires a passive patient.
Accuracy: ± 2cmH20 or ± 5%, whichever is greater
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Operator’s Manual
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
H-5
AutoPEEPES
AutoPEEPES is defined as the difference between esophageal pressure measured at the end of
exhalation (PEEPES) minus the esophageal pressure measured at the start of a patient-initiated breath
(PES start) and the sensitivity of the ventilator’s demand system. The sensitivity of the ventilator’s demand
system is the difference between the baseline airway pressure (PEEPAW) and the airway pressure when
the patient initiates a breath (PAW start).
AutoPEEPES = (PEEPES − PES start) − (PEEPAW − PAW start)
Range:
0 to 50 cmH2O
Resolution:
1 cmH2O
Note:
Requires an esophageal balloon catheter.
Accuracy:
± 2cmH20 or ± 5%, whichever is greater
Transpulmonary Pressure, Plateau (Ptp Plat)
The ventilator is capable of calculating and displaying the Transpulmonary pressure during an inspiratory
hold, which is the difference between the airway plateau pressure (PPLAT AW) and the corresponding
esophageal pressure.
PtpPlat = PPLAT AW − PES
Range:
−60 to 120 cmH2O
Resolution:
1 cmH2O
Accuracy:
± 2cmH20 or ± 5%, whichever is greater
Note
Requires an inspiratory hold and an esophageal catheter.
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H-6
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
AVEA Ventilator Systems
Transpulmonary Pressure, AutoPEEP (Ptp PEEP)
Transpulmonary pressure, AutoPEEP (PtpPEEP) is the difference between the corresponding airway and
esophageal pressures at the end of the expiratory hold during an AutoPEEP maneuver.
PtpPEEP = PAW − PES (at the end of an expiratory hold)
Range:
−60 to 120 cmH2O
Resolution:
1 cmH2O
Accuracy:
± 2 cmH2O or ± 5%, whichever is greater
Note:
Requires an expiratory hold and an esophageal catheter.
Maximum Inspiratory Pressure (MIP)
Maximum Inspiratory Pressure (MIP), is the maximum negative airway pressure that is achieved by the
patient, during an expiratory hold maneuver.
Range:
−60 to 120 cmH2O
Resolution:
1 cmH2O
Accuracy:
± 2cmH20 or ± 5%, whichever is greater
Respiratory Drive (P100)
Respiratory Drive (P100), is the negative pressure that occurs 100 ms after an inspiratory effort has been
detected.
P100 = Pend 100 − PEEPAW
Range:
−60 to 120 cmH2O
Resolution:
1 cmH2O
Accuracy:
± 2cmH20 or ± 5%, whichever is greater
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Operator’s Manual
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
H-7
Ventilator Work of Breathing (WOBV)
Ventilator Work of Breathing (WOBV), is defined as the summation of airway pressure (PAW) minus the
baseline airway pressure (PEEPAW) times the change in tidal volume to the patient (ΔV) during
inspiration, and normalized to the total inspiratory tidal volume (Vti).
If PAW > PEEPAW ,
∑ (P
AW
WOBV =
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− PEEPAW )ΔV
Insp
Vti
Range:
0.00 to 20.00 Joules/L
Resolution:
0.01 Joules/L
Accuracy:
± 10%
H-8
Appendix H Advanced Pulmonary Mechanics Monitored Parameters
AVEA Ventilator Systems
Patient Work of Breathing (WOBP) (Normalized to Delivered Tidal Volume)
Patient Work of Breathing (WOBP), normalized to the total inspiratory tidal volume. Patient work of
breathing is defined as the summation of two work components: work of the lung and work of the chest
wall.
WOBP = WOBLUNG + WOBCW
Tiend
∑ ( PEEP
where WOBLUNG =
ES
− PES )ΔV
(if PEEPES > PES and V > 0)
Testart
and WOBCW =
VP 2
(if PEEPES > PES)
2CCW
Work of the lung (WOBLUNG) is calculated using esophageal pressure when the baseline esophageal
pressure (PEEPES) is greater than the esophageal pressure (PES), indicating patient effort.
Work of the chest wall (WOBCW) for a spontaneously breathing patient is calculated using only the portion
of the total tidal volume delivered due to a patient effort (VP) and the chest wall compliance (CCW).
Range:
Resolution:
Accuracy:
0.00 to 20.00 Joules/L
0.01 Joules/L
± 10%
Note
Requires an esophageal balloon catheter.
Imposed Work of Breathing (WOBI)
Imposed Work of Breathing (WOBI), is defined as the work performed by the patient to breathe
spontaneously through the breathing apparatus, i.e. the E.T. tube, the breathing circuit, and the demand
flow system.
Imposed work is assessed by integrating the change in tracheal pressure and tidal volume, and
normalizing the integrated value to the total inspiratory tidal volume (Vti). (Requires the use of an optional
tracheal catheter.) Based on the following formula:
WOBI =
∫ (PEEP
Vti
AW
0
− PTR ) *
dV
,
dt
where PEEPAW = airway baseline pressure
PTR = tracheal pressure
Vti = inspired tidal volume
Range:
Resolution:
Accuracy:
0.00 to 20.00 Joules/L
0.01 Joules/L
± 10%
Note
Requires a tracheal catheter
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I-1
Operator’s Manual
Appendix I
Glossary
Breath Interval
Preset
Trigger
BTPS
ATPD
Demand Flow
AC
Bias Flow
bpm
Breath Period
Breath Rate
BTPD
Button
cmH2O
Controls
Event
Flow
Indicators
L
LED
L/min
Mode
Monitored Parameter
O2
Patient Breathing
Circuit
Paw
PEEP
Ppeak
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Elapsed time from the start of one breath to the start of
the next.
An operator set ventilator parameter.
Value at which the ventilator initiates delivery of a breath
as a result of measured patient effort.
Body Temperature at Ambient Pressure, Saturated.
Ambient Temperature, Ambient Pressure, Dry.
The flow generated by the ventilator to meet the patient’s
flow demand in order to maintain PEEP at the preset
level.
Alternating Current (mains electricity).
Flow through the patient breathing circuit during the
expiratory phase. This flow is used for flow triggering.
Breaths per minute.
The length of time between machine-initiated breaths.
Depends on the Breath Rate setting.
The number of breaths delivered in a minute.
Body Temperature at Ambient Pressure, Dry
A push button switch used to toggle a function on or off.
Centimeters of water pressure.
Any button, switch, or knob that allows you to modify the
ventilator’s behavior.
The occurrence or activation of certain controls or
functions of the ventilator or a patient care activity, which
can be stored in the trend buffer.
The rate at which gas is delivered. Measured in liters per
minute (L/min).
A visual element showing operational status.
Liters. A unit of volume.
Light Emitting Diode
Liters per minute. A unit of flow.
An operating state of the ventilator that determines the
allowable breath types.
A measured value displayed in the monitor window.
Oxygen
The tubing that provides the ventilatory interface between
the patient and ventilator.
Airway Pressure. Measured in cmH2O.
Positive End Expiratory Pressure. Pressure maintained in
the circuit at the end of exhalation.
Peak Inspiratory Pressure. Shows the highest circuit
pressure to occur during inspiration. The display is
updated at the end of inspiration. Ppeak is not updated for
spontaneous breaths.
I-2
Appendix I Glossary
Pplat
PSIG
Sigh Breath
WOB
AVEA Ventilator Systems
Plateau Pressure. Measured during an Inspiratory Hold
maneuver or during zero flow in a pressure control breath.
Used to calculate Static Compliance (Cstat).
Pounds per square inch gauge. 1 PSIG = .07bar
A Volume Controlled machine breath having a tidal
volume equal to one-and-a-half times (150%) of the
current tidal volume setting.
Patient Work of Breathing i.e. a measure of Patient Effort.
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I-3
Operator’s Manual
Index
A
access the advanced settings group · 3-37
activating a primary breath control · 3-32
active humidifier · 2-6
adult patient circuit · 2-6
advanced settings · 3-37
accessing the screen · 3-37
advanced settings indicator · 3-37
bias flow · 3-42
flow cycle · 3-41
insp rise · 3-41
machine volume · 3-40
pres trig · 3-42
PSV cycle · 3-43
PSV rise · 3-43
PSV Tmax · 3-43
sigh · 3-42
volume limit · 3-39
Vsync · 3-42
Vsync rise · 3-43
waveform · 3-41
air inlet pressure · 4-22, D-2
air supply · 2-1
alarm conditions · 6-11
alarm indicator · 6-4
alarm indicators · 3-8
alarm limits · 6-5
alarm loudness · 2-18
alarm reset button · 6-6
alarm silence · 6-5
alarm types · 6-6
alarms · 6-4
apnea interval · 6-10
extended high peak pressure · 6-8
fan failure · 6-6
high exhaled minute volume · 6-9
high O2 percent · 6-11
high peak pressure, normal · 6-7
high peak pressure, sigh · 6-8
high priority · 6-4
high rate · 6-10
high tidal volume · 6-10
IE ratio · 6-11
loss of air · 6-7
loss of gas supply · 6-7
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loss of O2 · 6-7
low exhaled minute volume · 6-9
low O2 percent · 6-11
low peak pressure · 6-7
low PEEP · 6-8
low priority · 6-4
maximum inspiratory time · 6-10
medium priority · 6-4
safety valve open · 6-6
vent inop · 6-6
annual maintenance · 7-3
apnea backup
CPAP or APRV / BIPHASIC · 3-25
apnea back-up ventilation · 3-14
Artificial Airway Compensation · 3-10
assemble and insert the exhalation filter and water trap · 2-3
assembly on site · 2-1
assist control ventilation mode · 3-19
attaching the flow sensors · 2-8
attaching the patient circuit · 2-6
autoclave · 7-2
B
Backup Alarm · 6-4
Barometric Pressure · 2-21, 6-3
base flow · 3-42
battery cord · 2-3
battery pack · 7-4
external · 7-4
battery replacement · 7-5
battery status indicator · 6-2
battery status indicators · 7-5
bias flow · 3-36, 3-42, I-1
breath interval · 3-4, 3-19, 3-20, 3-33
breath interval timing mechanism · 3-19
breath rate · 3-19, 3-20, 3-33, 4-21, 4-26, 6-10, 6-12, D-1
breath type and delivery mode · 3-14
breath types · 3-15, 3-20, I-1
breath types and modes by patient size
adult and pediatric · 3-30
breaths, defined by four variables · 3-15
C
calculated IE Ratio · 4-26
calculated minute volume · 4-26
Index-4
cautions · xi
choice of waveforms · 4-2
circuit compliance · 1-3, 3-11
circuit compliance compensation · 1-3, 3-11
Circuit Occlusion Alarm · 2-30
cleaning and sterilization
accessories and parts · 7-1
external surfaces · 7-1
colors on waveform display · 4-1
compliance effect of the circuit · 1-3, 3-11
compressed gas sources · 2-1
connecting the O2 sensor · 2-15
contacting the manufacturer · A-1
control knob · 4-2, 4-3, 4-20, 4-27, 6-5
controls associated with each breath type & mode · 3-38
cord routing · 2-3
CPAP/PSV mode · 3-14, 3-18, 3-23
customer service · A-2
AVEA Ventilator Systems
F
flashing alarms · 6-4
flow cycle · 3-41
flow trig · 3-31
freezing a loop · 4-5
freezing the loops screen · 4-5
fuses · 7-7
G
gas line pressure · 2-1
gas sources · 2-1
air supply · 2-1
oxygen supply · 2-1
graphs · 4-3
H
D
data dial · 3-32
default mode for all patient types · 3-19
demand breaths · 3-18
disable the audible alarm · 6-5
displayed value · 3-32
dynamic compliance · 4-22, D-2
E
electromagnetic components · viii
EMC · viii
Enable/Disable O2 Alarms · 2-18
enzyme pre-soaking solution · 7-1
esophageal balloon · 2-11
connection · 2-11
event log · 4-24
event markers · 4-23
events · 4-24
events automatically recorded · 4-24
exhalation filter · 2-3, 2-4, 2-5, 7-1, 7-2
exhaled tidal volume · D-1
adjusted for ideal body weight · D-1
expiratory Time · 4-21, D-1
expired tidal volume · 4-21
adjusted for patient weight · 4-21
external battery · 2-26, 7-5
external water trap · 2-15
Heliox connection · 2-16
heliox delivery · 1-4
high priority alarm · 6-4
hot wire sensor · 2-8
humidification · 1-3, 2-6, 3-12
I
independent lung ventilation · 2-19, 3-44
indicators · 6-1
external battery · 6-1
internal battery · 6-1
mains AC · 6-1
inhaled tidal volume · D-1
adjusted for ideal body weight · D-1
insp pause · 3-31
insp pres · 3-31
insp rise · 3-41
insp time · 3-31
inspiratory pause · 3-34
inspiratory pressure · 3-33
inspiratory time · 3-34, 4-21, D-1
Inspiratory/Expiratory ratio · 4-21, D-1
inspired tidal volume · 4-21
adjusted for patient weight · 4-21
internal battery · 2-26, 7-5
L
leak compensation · 3-11
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5
Operator’s Manual
loops
colors · 4-1
comparing loops · 4-5
freezing a loop · 4-5
reference · 4-5
reference loops · 4-5
saving a loops · 4-5
selection · 4-4
loops in real time · 4-4
loops screen · 4-4
low priority alarm · 6-4
M
mach vol · 3-40
main screen monitors · 4-27
mandatory breath · 3-15
mandatory tidal volume · 4-21, D-1
adjusted for patient weight · 4-21, D-1
mean inspiratory pressure · 4-22, D-2
medium priority alarm · 3-8, 6-4
membrane button
expiratory hold · 3-4
membrane buttons
accept button · 3-4
advanced settings · 3-6
alarm limits · 3-3
alarm reset · 3-2
alarm silence · 3-2
cancel · 3-4
freeze · 3-7
increase O2 · 3-3
inspiratory hold · 3-5
main · 3-8
manual breath · 3-3
mode · 3-7
nebulizer · 3-5
panel lock · 3-6
print · 3-6
screens · 3-8
setup · 3-6
suction · 3-3
membrane buttons and LEDs · 3-2
minute volume · 4-21, D-1
adjusted for patient weight · 4-21, D-1
monitor screen · 4-20
monitored values · 4-20
monitored values choices · 4-21
multiple alarms · 6-4
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N
nebulizer · 2-9, 3-5
neonatal patient circuit · 2-7
new patient key · 3-9
NIST fittings · 2-15
O
O2 percentage · 3-31
optional external battery · 2-3
ordering parts · A-1
oxygen inlet pressure · 4-22, D-2
oxygen sensor · 2-14
cable · 2-15
cell · 2-15
oxygen supply · 2-1
P
parallel printer port · 2-13
passive humidifier or HME · 2-6
patient effort · 3-19, 3-20, I-1
patient ID · 3-12
patient select screen · 3-9
patient size · 1-2
patient size indicators · 3-6
patient size select screen · 3-9
patient-triggered breaths · 3-18
peak Expiratory flow rate · 4-22, D-2
peak flow · 3-31
peak Inspiratory flow rate · 4-22, D-2
peak inspiratory pressure · 4-21, D-2
PEEP · 3-16, 3-17, 3-18, 3-31, 3-33, 3-35, 3-42, 4-22, 6-6,
6-7, 6-8, 6-11, 6-12, D-2, I-1
percent leakage · 4-21, D-1
percentage of oxygen · 4-22, D-2
plateau pressure · 4-22, D-2
positive end expiratory pressure · 3-35, 4-22, D-2
power cord · 2-26
power on indicator · 6-1
power source · 2-1
pres high · 3-31, 3-36
pres low · 3-31
pres trig · 3-42
pressure breaths · 3-16
pressure high control · 3-36
pressure low control · 3-37
pressure regulated volume control breaths · 3-17
pressure support ventilation · 3-23
Index-6
preventive maintenance · 7-3
primary breath controls · 3-31, 3-33
breath rate · 3-33
flow trigger · 3-36
inspiratory pause · 3-34
inspiratory pressure · 3-33
inspiratory time · 3-34
PEEP · 3-35
pressure high · 3-36
pressure low · 3-37
pressure support · 3-34
tidal volume · 3-33
time high · 3-36
time low · 3-36
printing · 4-3
protective ground connection · 2-26
PSV · 3-31
PSV breath · 3-18
PSV control · 3-34
PSV cycle · 3-18, 3-43
PSV rise · 3-43
PSV Tmax · 3-18, 3-44
R
radio frequency energy · viii
rapid shallow breathing index · 4-21, D-2
rate · 3-31
rear panel diagram · 2-14
reference loop · 4-5
remote nurse call system · 2-24
replaceable fuses · 7-6
respiratory system resistance · 4-22, D-2
resume button · 3-29
resume current key · 3-9
S
safety information · x
save loop button · 4-5
saving a loop · 4-5
scaling histograms · 4-25
screen select box · 3-28
screens
mode selection · 3-14
patient select · 3-9
patient size · 3-9
ventilation setup · 3-10
sequence in which the power sources are used · 7-5
service calls · A-1
AVEA Ventilator Systems
Setting Date · 2-25
setting the breath type and ventilation mode · 3-14
Setting the Language · 2-21
Setting the Time · 2-25
setting up your AVEA ventilator · 2-1
sigh · 3-42, 6-7, 6-8, 6-11
sigh volume breaths · 3-42
SIMV mode · 3-20
smart connectors
attachment · 2-16
smart Heliox connectors · 2-16
specifications
accessories · B-6
atmospheric & environmental · B-5
data input & output · B-3
electrical · B-1
physical dimensions · B-5
pneumatic · B-1
spontaneous breath · 3-18
spontaneous breath rate · 4-21, D-1
spontaneous minute volume · 4-21, D-1
adjusted for patient weight · 4-21, D-1
spontaneous tidal volume · 4-21, D-1
adjusted for ideal body weight · D-1
adjusted for patient weight · 4-21
standby mode · 3-28
static compliance · 4-22, D-2
status indicators · 6-1
steam sterilization · 7-2
symbols · xii
synchronized intermittent mandatory ventilation · 3-20
T
tidal volume · 3-33
time cycled pressure limited breaths · 3-16
time high · 3-31, 3-36
control · 3-36
time low · 3-31, 3-36
control · 3-36
tracheal catheter · 2-11
trade names · viii
trended data · 4-25
histograms · 4-25
spreadsheet · 4-25
trends screen · 4-25
V
variable orifice sensor · 2-9
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7
Operator’s Manual
ventilation modes · 3-19
ventilator specifications · B-1
ventilator synchronization · 2-19
VGA output connector · 2-13
visual alarm display · 6-4
volume breaths · 3-15
volume limit · 3-16, 3-39
Vsync · 3-42
pressure control breaths · 3-42
volume test breath · 3-42
Vsync rise · 3-43
Vt · 3-31
L2786
W
warnings · x
warranty · iv
water collection bottle · 2-3
water trap · 2-3, 2-4, 7-1
waveform · 3-34, 3-41, 4-2, 4-3, 4-27
choices · 4-3
waveforms
colors · 4-1
freeze · 4-3
freezing · 4-1
main screen · 4-1
menu · 4-2
printing · 4-3
Index-8
AVEA Ventilator Systems
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